RIVIAM enables multi-agency working for Integrated Neighbourhood Teams

RIVIAM’s Multi-agency Referral Hub is a secure, shared digital platform that enables NHS, social care and VCSE partners to receive referrals and securely work together online to co-ordinate care and support around an individual.

RIVIAM sits alongside existing NHS and Local Authority systems, integrating seamlessly so information flows and teams can collaborate around a single shared view.

It streamlines referral and case management so services can collaborate as one Integrated Neighbourhood Team, reduce duplication and deliver a more person-centred approach.

Download the Case Study.

Introduction

Set up in March 2020 to respond to the COVID-19 crisis, the Community Wellbeing Hub (CWH) in Bath and North East Somerset (BaNES) uses RIVIAM’s Multi-agency Referral Hub service to co-ordinate health, social care and VCSE services for adults and their families.

The hub is a ‘one stop shop’ for people to request support for food, medicine, mental health or welfare and receive a co-ordinated response from Everyone Health BaNES, BaNES Council and many VCSE services such as Age UK BaNES, Citizens Advice BaNES and Bath Mind.

Underpinning the hub’s operation, RIVIAM provides a shared referral management system so authorised users from the different organisations can collaborate. Everyone can see a single view of a person’s care and organisational boundaries are removed.

The challenge

With the NHS 10 Year Health Plan for England*, there is a renewed ambition to improve care through more joined-up Integrated Neighbourhood Teams.

Communication across different health, social care and VCSE organisations is vital but organisations using different IT systems find it difficult to share information and work together.

Also, VCSE organisations do not always have the digital capabilities to communicate efficiently with their health and social care partners; they are reliant on phone, email and spreadsheets to share information.

This lack of ability for partners to easily and securely co-ordinate care and subsequent actions can lead to slow decisions, wasted resources and an increased risk of delayed care.

To respond to the COVID-19 crisis in March 2020, the CWH needed a way for local teams from different organisations in BaNES to work together, share resources and co-ordinate care.

With the current cost of living crisis and need to deliver Integrated Neighbourhood Teams, this challenge for the hub remains.

RIVIAM's solution

Since March 2020, 38 partner organisations have used RIVIAM’s Multi-agency Referral Hub to co-ordinate support for local people through a single, shared digital hub including Hospital to Home support from the Royal United Hospitals Bath and community hospitals.

Referrals from phone, online forms and ward processes are routed into configured pathways, with role-based security and a single auditable record. Red, Amber and Green statuses are set for each pathway to highlight the length of time a case has been in the system.

RIVIAM seamlessly integrates with existing clinical systems and EPRs so information flows, and health and social care organisations can work together around a single record.

Tasks are shared and managed across agencies and Multi-disciplinary Team Meetings (MDTs) are enabled and support more transparent communications.

By streamlining referrals and tracking across services, RIVIAM helps reduce costs, streamline workflows and eliminate duplication, so partners can deliver the right care, at the right time, using the right information. 

BENEFITS

Benefits for organisations

• Transforms delivery of Integrated Neighbourhood Teams, team working, multi-agency delivery.
• Health and social care and VCSE partners work together collaborating securely, efficiently.
• Streamlines referral and case management processes for partners, creates efficiencies.
• Single patient record, partners only see relevant information through role-based access.
• Enables delivery of more personalised, responsive patient care.
   

Outcomes for people in BaNES

• There is no ‘wrong door’ to access services.
• Services are ‘wrapped around’ individuals. No person is ever left without support or an agreed plan of step down support.
• Gaps in care can be identified more easily and support put in place.
• People receiving support don’t have to waste time repeating conversations as services have access to the person’s record, if they have the rights to do so.
• Medically fit people can leave hospital quicker with access to care.