Integrated Care Exeter: Inter-Disciplinary Team

In 2014, local agencies embarked on an ambitious partnership journey to better integrate the ways that health and social care services are delivered, to offer better, more efficient services with improved outcomes, more of a preventative focus, and – ultimately – reduced demands resulting in reduced resource spends. The programme was called Integrated Care Exeter, or ICE.

Much of the focus was inevitably place upon services to frail elderly people, but within ICE’s scope was also a project strand concerned with the health needs of people who are homeless or vulnerably housed. Exeter has the second highest rate of rough sleeping outside of London, and the life expectancy of a male rough sleeper is 47. For a woman it is just 43. In Topsham, Exeter’s most affluent ward, life expectancy is 85.

People with multiple and complex needs (that is, people that are homeless or vulnerably housed, with concurrent issues with addiction, mental health, or offending) are often involved with multiple organisations, commissioned separately, that they engage with. These services have differing thresholds, wait times, and are delivered in different locations. This can lead to fragmented service delivery, differing interventions taking place at different times – and achieving poor outcomes as a result. 

CoLab is now hosting an inter-disciplinary team as a test of change – pulling together staff from a range of disciplines (housing, addiction, criminal justice, mental health and social care organisations) to form an assertive, proactive team that work to deliver whole integrated packages of intervention to people for whom conventional models of service delivery have not worked despite multiple engagements.

The team went live in October 2017 and will run as an experiment initially until March 2018, and works with a caseload of 20-25 of the most entrenched people at any given point. To contact the team, please call 01392 284271 or email iceteam@exetercvs.org.uk