Health and social care in the UK has reached a turning point as it confronts three burning platforms – global economics, demographic challenges and increased expectations from service users.
Effective integration will be part of the fresh thinking on health and social care that will be vital to addressing these growing challenges and there are already some inspirational demonstrations of integration of clinical pathways and commissioning arrangements. These have successfully minimised transactional costs while also improving quality of care and patient experience. But what are the lessons for success?
Health and social care leaders gathered at PA Consulting Group's global headquarters to explore how health and social care integration can be achieved at scale and pace. Guests head from NHS England (London Region), London Borough of Ealing, London Borough of Hounslow, London Office of Clinical Commissioning Groups, Help&Care, Dorset County Council and South London Academic Health Science Network.
The following headline points emerged from the evening’s discussions:
Imposing of an off-the-shelf solution on health and social integration can create more problems than it solves. Instead, successful models must be adapted to suit the needs of local populations. The focus should be on developing integrated health and social care services that combine an innovative approach, best practice and local priorities to create a truly fitting integration model.
A simple compelling narrative on health and social care integration is needed to draw people in, and should use examples that can be easily related to and understood. National Voices powerfully demonstrates the purpose of integration: "I can plan my care with people who work together to understand me and my carer(s), allow me control, and bring together services to achieve the outcomes important to me.” 1
With clarity of ambition, health and social care commissioners and providers can pursue small changes that build towards the same goal. Leaders must balance their efforts between making progress in one specific area and maintaining a view of the health and social care system as a whole.
It is also important to create transparency over money flows and design incentives that are aligned with the desired changes. The Better Care Fund may prove to be a good catalyst, as would the introduction of a ‘Plagiarism Prize’ to celebrate local adoption of great integration practice developed elsewhere.
New and innovative technology, rapid communication and information sharing between services and stakeholders can disrupt established norms. These should be exploited to re-imagine health and social care delivered in the home setting and reach the public on multiple platforms.
Leadership of health and social integration is invariably distributed with no single body in full authority, which may be seen as a major drawback. But accountability can only be truly vigorous if scope is limited, which for the integration of health and social care services will not be the case.
Accountability for health and social care integration should ultimately be placed where change is needed; this should be where there is greatest potential to influence and improve. Changes to health and social care services rely on behaviours and the opinions of the public, commissioners, clinicians, providers and politicians. Health and Wellbeing Boards (HWB) bring these groups together and may therefore act as an important focus in enabling change. It is early days for HWBs, but in time, with suitable leadership development and guidance, they may prove to be the best home for the accountability for health and social care integration.
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