Delivering public services through equal and reciprocal relationships between providers and the communities they serve should be at the heart of commissioning community services, and achieving integrated care, says Victor Adebowale.
This is a critical time in the development of health policy. The pause is over and the new direction for the NHS and for commissioning is finally emerging.
What we need now, though, is a robust debate about how best to ensure care is integrated around people and their communities.
Care is a key quality marker in health and must be commissioned wisely. For me, commissioning is the means by which we understand the needs of an individual or a community in order to build a platform for procurement.
In the face of so much uncertainty, clinical commissioning groups need to reach out to communities. They need to see them as an asset and develop new behaviours and skills.
This is why co-production is so important for an effective commissioning system. For those new to the term, co-production means designing and delivering public services through equal and reciprocal relationships.
“Equal and reciprocal” means professionals working together with the very people who use services and with their families and neighbours. It’s about both services and neighbourhoods becoming far more effective agents of change. By involving communities, co-production is effective in tackling health inequalities and improving mental health.
There is already good evidence that co-production works for communities. Research studies show that a people-centred approach delivers improved quality, innovation and better outcomes for people, the community and the care system. The benefits are also outlined in a new report published this month by Turning Point, NHS Alliance and National Voices called Raising The Bar. Our report shows that co-production reconnects people by building and reinforcing social networks. There is another benefit too: these equal partnerships achieve these results at a lower cost.
By achieving better value, co-production becomes an essential element of the delivery of quality, innovation, productivity and prevention across the NHS.
As members of the NHS Alliance PPI Network, Turning Point, and National Voices want to put co-production centre stage at this critical time.
We are not naïve. We know there is a huge challenge ahead. This symbiotic way of working means power must be shared, for example, between commissioners, local people and communities. It means shared resources and joint budgets. Until now, joint budgeting has generally been narrow and controlled mainly by statutory bodies.
A change in approach challenges deeply entrenched cultural norms, yet change is also the big prize- and a necessity. There is only one way to ensure a free NHS survives: by enabling people to take control of their lives so they become less reliant on formal health and related services.
Policy makers from across government also need to work more closely together. They need to formulate policy in a joined-up way that supports clinical commissioners with partners such as local authorities, education and police to drive co-produced care.
The challenge is to scale-up the co-production approach in health. We also need to harness the opportunities offered by the current changes in health commissioning.
There are four big things that need to happen very soon if this challenge is to be met. First, we need to create local community resources then change culture and behaviours. Planning must be joined-up through Health and Well Being strategies and the joint strategic needs assessment. Lastly, we need to build evidence, transparency and accountability to communities.
The Health Empowerment Leverage Project (HELP) in Dartmouth is one example of how co-production is successful in improving quality and outcomes. Based on resident-led partnerships, HELP focuses on issues that matter for local residents living on six deprived rural and urban housing estates. Residents benefit from a seven step training programme so they can apply the system in their area.
In just one year, HELP has achieved impressive results. A new dental service has been set up, anti-social behaviour has reduced, a derelict area has been transformed into a play park and relations between tenants and the local housing association have got better. HELP’s ultimate goal is to improve health. Yet the project demonstrates that listening to communities may mean focusing first on issues such as anti-social behaviour, crime and building social networks. In the long run, this early listening and problem solving leads to improved health outcomes, and communities are supported to heal themselves.
Co-production can also be used to rewrite the way primary care services are delivered. GPs at Smethwick Medical Centre in the West Midlands have been ensuring patients with long-term conditions receive group consultations to promote self-management. The centre has been working with Pathfinder Healthcare Development (PHD) and Aetna Health Services UK on a care management programme to ensure patients also see the right person, at the right time in the right place. This way patients are not dependent on health professionals. The result has been a reduction in the use of secondary care services. If made widespread, this approach could prove a powerful driver of cultural change in general practice.
In the drive towards co-production, I believe that JSNA along with the work of Health and Well Being Boards and their commissioning approach will be key. The JSNA should become a reflection of people’s lived experiences in the local community. From the outset, it must build a vision for the future and involve the community. It is essential that public health and other relevant data is used to inform commissioning and the JSNA.
Turning Point has been delivering our own model of community-led commissioning called Connected Care in 11 areas, since 2006. In Hartlepool, one of the Connected Care areas, an audit of 251 local residents was undertaken to understand their needs and the priorities of the community. Thisinformed the development of the Connected Care service that is delivered through a local community social enterprise. Top of the list was a debt and benefits advice service and support for older people to stay in their homes for longer.
Over the next 12 months, the newly formed clinical commissioning groups will be working with their partners and residents to develop a shared vision of the future they plan to create.
My hope is that CCGs will be inspired to put co-production at the centre of that vision. After all, the remit of the NHS Commissioning Board is to “promote innovative ways to integrate care for patients.” Raising The Bar demonstrates that co-produced projects such as Connected Care are innovative in integrating care because they give patients a voice.
I want co-production in health to become “the way we do things around here” and for shared resources and joint budgets to become the rule, not the exception. If this is realised then CCGs could lead a significant system change and have a profound impact on people’s lives.