Adult complex care

Tower Hamlets CCG is working with local health providers and Tower Hamlets Council to transform the way that we care for adults with complex health needs. This includes those who are elderly, frail and/or have multiple health conditions.

We are committed to establishing a high quality and effective integrated care programme which means that these people have access to:

  • A personalised care plan
  • A case manager to help coordinate their care
  • A multi-disciplinary team of health and social care professionals in the community, including specialist consultants in geriatrics and psychiatry
  • Services that are able to rapidly respond should their condition deteriorate quickly or unexpectedly

To date, we have enrolled more than 6,000 people onto this programme. As of January 2017, we had prevented 2,287 A&E attendances and hospital admissions.

We have also been working to make sure that people receive the care they need outside of a medical setting. This has included:

  • Offering support for people with long-term conditions to manage their own health, delivered in the community by our partners in the voluntary sector. This support allows people to take steps to manage the day-to-day impact of living with their condition.
  • Linking people to activities in their local community that they might benefit from, using social prescribing. In Tower Hamlets, two GP practices (Bromley by Bow and Mission Practice) recently successfully piloted an approach to social prescribing. In Bromley by Bow, 95% of healthcare professionals surveyed reported seeing a benefit to their patients, while Mission Practice saw a 27% reduction in appointments, telephone calls and home visits. This approach has now been rolled out to every practice in Tower Hamlets.
  • Working closely with our local mental health providers to deliver additional mental health support for people with long-term conditions, based on research from the Mental Health Network which estimates that in the UK, 30% of people with a long-term condition also have a mental health issue.
  • Delivering a national programme called Integrated Personalised Commissioning (IPC). The purpose of this programme is to enable people, carers and families to have greater choice, flexibility and control over the resources and funding available to them, allowing them to organise their own care.

Feedback

For more information or to give feedback on any of the information on this page, please email us.