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Feature Service Integration

A glimpse of the future of healthcare at the seaside

BMJ 2011; 342 doi: (Published 28 March 2011) Cite this as: BMJ 2011;342:d1917
  1. Peter Davies, freelance journalist
  1. 1London, UK
  1. petergdavies{at}

Combining health and social care at a seaside authority on the south coast of England has proved so successful it’s prompted the NHS chief executive to anoint it as “the future.” Peter Davies investigates

An 85 year old woman living alone in Torbay has transformed health and social care there. Mrs Smith helped the NHS and the local authority break down barriers that elsewhere have dogged attempts to integrate services. So successful has she been that NHS chief executive, David Nicholson, declared: “I’ve seen the future. It’s Torbay.”

Mrs Smith is known to all local general practitioners, health and social care staff, patients, and carers, who immediately recognised her experiences of the frustrations, delays, and duplicated effort inherent in navigating a fragmented system. For several years no discussion about health or social care in Torbay has taken place without her.

In reality Mrs Smith is a fictitious character invented by the then chief executive of the newly formed Torbay care trust, which combined health and adult social care in 2005. By contrasting her story with a vision of how integrated services could operate under the care trust, she became a powerful symbol of the new organisation.

“When we started, no presentation in this organisation would happen without talking about Mrs Smith, and we still do it now,” says Mandy Seymour, the care trust’s chief operating officer. “We were trying to get everyone to understand what we wanted to achieve: being focused on the needs of the patient. It’s very simple. Everything we do is around delivering benefits to Mrs Smith.”

Those benefits have been remarkable. Torbay has the lowest rate of emergency admissions in south west England: even after a harsh winter they were 3% below contracted levels for this year. By developing intermediate care services, acute beds have been …

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