The Torbay Model – “Mrs Smith”

Our predecessor organisation, Torbay and South Devon Health and Care NHS Trust (2005-15) was originally created because we believed that bringing health and social care services together would better meet the needs of local people who needed care and support.

This work started in Brixham in 2004 where a pilot project brought health and social care workers together into a single team operating under the leadership of a manager in charge of all health and social care services.

To guide this work, we developed a story about “Mrs Smith”, a typical older lady who needed a range of services. It was clear from the earliest stages that this was a powerful approach and traditional measures of success (such as waiting times for assessment) indicated almost immediate improvements. Both our staff and people who used our services also reported improvements. And by planning services to suit someone with complex needs we improved our ability to deliver care across the whole organisation.

Torbay was one of the first areas in the country to benefit from this integration of health and social care and ‘the Torbay model’ and ‘Mrs Smith’ received national and international interest. Although many organisations are now focusing on integrated care, our innovative approach remains an early example of excellence.

The results of integration had a significant impact for our local health and social care communities as identified in a Kings Fund paper in 2010 which found that in the Torbay area:

• the daily average number of occupied beds fell from 750 in 1998/99 to 502 in 2009/10
• emergency bed day use in the population aged 65 was the lowest in the region at 1920 per 1000 population compared with an average of 2698 per 1000 in 2009/10
• emergency bed day use for people aged 75 and over fell by 24 per cent between 2003 and 2008 and by 32 per cent for people aged 85 and over in the same period
• delayed transfers of care from hospital were reduced to a negligible number and this was been sustained over a number of years
• by 2009/10 we were financially responsible for 144 fewer people aged over 65 in residential and nursing homes
• there has been a corresponding increase in the use of home-care services.

We maintain our international contacts and continues to be involved in national projects. We became one of the 16 localities in the government’s Integrated Care Organisation pilot programme in 2009 (Wilding 2010[1]).

[1] Integrating Care: “From Horizontal to Vertical Integration” Journal of Integrated Care, Vol 18 Iss 3 Wilding 2010