Nursing Opinion

Integrated care is needed now, more than ever

Sara-Marie Black, Project Manager at Warrington Together

As Warrington Together’s Project Manager my role is to lead on the development of Integrated Community teams for the borough. The role encompasses everything from health and social care to third sector organisations and voluntary services.

I have used my experience and knowledge from my previous roles as a community staff nurse, a district nurse and a district nurse coordinator to direct my approach and I built on my experiences to develop a system-wide approach to health and social care for Warrington. Over the last year, I have developed relationships across system partners and worked to establish a collaborative culture to improve patient experience and ensure they are always the focus – and so far, it seems to be working exceptionally well.

As a Project Manager, I provide clinical leadership to the integrated community teams, helping to support their development and the implementation of their services. I work closely with system leaders, clinical staff, service users and their families to understand the challenges across the system and to help the voices of the patients, service users and their families to be heard. I have developed these relationships through trust and open communication and have found this to be the best way to engage key stakeholders and work towards real, sustainable change.

For me, working in health and social care is a calling. I have always believed you do it because you are compassionate, positive, resilient, and because you can encourage empathy in others, too. It takes a certain type of person to have the flexibility to communicate effectively with so many different people and organisations, whilst always keeping a person-centred approach at the heart.

Working as Warrington Together’s Project Manager is a challenging role, but one which allows me to continuously drive for improved outcomes for the population of Warrington. Over the last few months, in response to COVID-19, I was redeployed in the single point of contact role for Warrington; meaning I worked as the interface between hospital discharge functions and community services to expedite discharge pathways.

During my redeployment, existing pathways within the Integrated Discharge Team were enhanced to support safe discharge of patients and enhance communication and build key relationships with stakeholders across both the community and within the acute setting.

During the COVID-19 crisis, by defining and developing the role of the professional nurse in complex discharge planning, we have embarked on a journey of moving from silo working to a nursing discharge function that is partway through its evolution and has a culture, training and development need attached to it.

By improving the information transfer between community care teams and hospitals (and vice versa) we can better connect staff and understand what detail and data is needed by each team. This means we can establish shared procedures for the teams and then support timely discharge for the patient.

Developing relationships is at the very heart of all I do. My passion lies in community nursing and I know that through improved communication and the sharing of resources, we can improve our relationships to better serve the communities we are part of. Nursing is vital to social care as it plays an important role in improving the quality of care delivered and, by extension, improves care outcomes. Including third sector organisations and voluntary services within these relationships will also go a long way in improving patient experience and community interactions. This collaborative approach is certainly  a route I think more of us working in care would do well to explore.

To deliver and improve care outcomes, you have got to care to begin with. You must want to create an environment that enables and fosters learning and new, innovative ways of thinking, that will open teams up to new ways of working. Ways that will really show the value of nursing and social care; giving a voice to not only patients but the staff that work so hard to support and care for those who need it most.

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