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Integrated Care Communities (ICCs)

The Bay Health and Care Partners Integrated Care Communities (ICCs) are made up of teams of health and care workers, voluntary organisations and wider partners who are working together to improve physical and mental health outcomes, promote wellbeing, reduce health inequalities and focus on wider determinants of health across the population in Morecambe Bay. 

Integrated Care Communities boundary map in Morecambe Bay.png

In Morecambe Bay there are eight ICCs which have been created to help bring together local health and care organisations:

  • Barrow and Millom 
  • Mid Furness 
  • Grange and Lakes 
  • Kendal 
  • East 
  • Carnforth 
  • Bay 
  • Lancaster 

A PDF version of the map of our ICCs can be downloaded here. 

The focus of ICCs is to ensure that people are supported to improve their own health and wellbeing and that when people are ill or need support, they receive the best possible joined-up care. The ICCs empower people to take an active role in their health and wellbeing and support them to manage their conditions at home. Everyone who is registered at a GP practice in Morecambe Bay belongs to an ICC.

During the Coronavirus (COVID-19) pandemic the ICCs have been involved in the #Ok2Ask campaign which encourages families and individuals across Morecambe Bay who have become vulnerable to ask for help. You can find out more about the #Ok2Ask campaign here

The below video looks at the amazing work and achievements of our Integrated Care Communities across Morecambe Bay during the coronavirus pandemic. 

Transcript

The Integrated Care Communities are integrated teams of health and care workers, voluntary organisations and wider community assets who work together to aim to improve physical and mental health outcomes, promote wellbeing and reduce health inequalities across an entire population including a focus on the wider determinants of health. 

The focus of Integrated Care Communities is to ensure that people are supported to improve their own health and wellbeing and that when people are ill and need support they receive the best possible joined-up care. 

The ICCs empower people to take an active role in their health and wellbeing and support people to manage their conditions at home with the right team around them. The ICCs work across organisations and in defined geographical areas. If you are registered to a GP practice within Morecambe Bay you will belong to an Integrated Care Community. 

Barrow ICC

Barrow and Millom ICC are a member of the Barrow Resilience Group to inform resilience and recovery work and to distribute information to the local community groups. 

The team supported the emergency hub with signposting and advice when necessary and identified sources of funding for inequalities in sport to support new physical activities for people with long-term conditions and long COVID. They also distributed wellbeing and mental health leaflets during COVID-19 across the community. 

Multi-disciplinary teams continued virtually very successfully. They also set up a family multi-disciplinary team in August and membership continues to grow. 

The under-18 alcohol and substance misuse project was set up with a wide range of partners including The Well Communities, Cumbria Alcohol and Drug Advice Service, The Community Alcohol Partnership and Drop Zone, was to support and educate children and young people and their parents or guardians. 

Young health champions were also given health coaching and training.

Millom ICC 

In Millom 457 welfare check phone calls were undertaken by the care navigator and over 40 cases management visits were carried out to the vulnerable in September. 

Millom submitted two funding bids and both were successful with a total of £10,000 being donated to the volunteers in Millom. There is close working will the Millom Around the Combe group. 

Millom is also a member of the West Cumbria Resilience Group and the Health and Wellbeing Action Group. 

There was a micro commissioning project launched for the community and there were nine bid proposals submitted for the health and wellbeing projects in Millom. 

Kendal ICC 

In Kendal Integrated Care Community approximately 2,000 welfare checks and home visits were undertaken. They helped to establish the Kendal self-isolation support group, alongside Kendal community emergency planning group and Gateway Church. 

Kendal ICC is also a member of the South Lakeland Resilience Group and were involved in the set up of the Ok2Ask campaign. 

Kendal Integrated Care Community is now co-located with Kendal Primary Care Network and they are working collaboratively on joint projects. They supported homeless people temporarily rehoused in the area to ensure they were registered with a GP and were assigned a social prescribing link worker. 

There frailty multidisciplinary team meetings were established virtually with higher attendance than pre-COVID. There has been some focus on social isolation prevention and continued food deliveries to Lunch Bunch attendees and received the High Sheriff Award for this work. 

During COVID the team volunteered for deployment to support the COVID command 

Mid Furness ICC

Mid Furness Integrated Care Community previously known as Ulverston, Dalton and Askam Integrated Care Community carried out 1,630 welfare checks and have set up a pilot post COVID peer support group. They have been working closely with Ulverston self-isolation group and have moved their women's and men's support groups to an online forum. 

Mid Furness ICC are also members of South Lakeland resilience group and have been exploring the development of the volunteer befriending scheme. They have identified sources of funding for community solutions to support new youth groups and have been actively involved in the Ok2Ask campaign. They have supported homeless people temporarily rehoused in the area to ensure they were registered with a GP and also had a multidisciplinary assessment where appropriate. 

Grange and Lakes ICC

In Grange and Lakes Integrated Care Community 555 welfare checks were undertaken. Four of their staff were redeployed to support key areas under pressure and have also successfully recruited and inducted three new members of staff, mainly remotely. They also are a member of the South Lakeland Community Resilience Group and work closely with their three main community isolation groups to provide information and support for them. Grange and Lakes were also involved in the Ok2Ask campaign

Bay ICC

Lee MacNeall, Development Lead for Bay ICC, joined our team in August. One member of staff left the team and one member of staff was recruited. Another member of staff was redeployed to support the COVID units. 

Bay ICC is a member of the Lancaster and Morecambe Wellbeing Resilience Group and work closely with the Primary Care Network. The multidisciplinary team meetings were moved to an online platform and the attendance has built up. Adult and frequent attenders are running at the moment with children and young people coming together. 

Lancaster ICC

Lancaster Integrated Care community joined two legacy ICCs with a shared demographic to become one. They developed the COVID community support bulletin that reached thousands of people during lockdown. This didn't just benefit our local communities but also staff working for the Trust to help them signpost people to different support groups and agencies. The team made over 2,100 shielding patient welfare calls and supported the voluntary, community and faith sector by developing new referral pathways into supportive services, worked collaboratively to develop a sustainable voluntary community and faith sector bay volunteer service. 

Lancaster ICC has also worked collaboratively to develop a North Lancs online digital directory of services. 

Carnforth ICC 

Carnforth Integrated Care Community is one of the smallest Integrated Care Communities across Morecambe Bay both geographically and in terms of patient numbers. During COVID our care coordinator received 78 referrals and has made 183 further signposts and referrals out to our local partners. We are a member of the community and faith support network and wellbeing and mutual aid groups. We've built on links with Carnforth Town Council and Carnforth and surrounding villages volunteer group to focus on local needs and support for our community. We are working closely with Carnforth community swimming pool who have obtained funds to pilot a project to allow people to get back into low impact exercise and to reduce social isolation. We've been heavily involved in the Ok2Ask campaign to support families and individuals who become newly vulnerable. 

East ICC

East Integrated Care Community has welcomed and inducted four new members of staff to our case management team during the COVID pandemic. The team have completed 105 care plan review calls and have made 136 signposts and onward referrals. 

East ICC is a member of the South Lakeland Resilience Forum and Craven Communities Together Partnership. We are also part of a working group focusing on support for teenagers across South Lakeland. 

We have also replicated the community support document created by Lancaster ICC but with a South Lakes focus to include a wealth of information about support agencies and signposting for our partners and communities to use. 

We have set up East ICC Children and Young People Steering Group to identify areas that we can work better together to support children and families within our local communities. 

We've restarted our monthly steering group meetings and they are now held online.