For people who need multiple care and support services over time, the announcement of the integration pioneers is a major advance, says Don Redding
For years, while personalisation has been transforming social care, there has been little impact on healthcare, where the knowledge and practical experience of how to implement person centred healthcare has been held among small circles of committed academics and practitioners.
Now, with momentum gathering behind coordinated care, greater understanding of service users’ preferences and demands, the further rollout of personal budgets, and growing interest in “house of care” approaches, we could be at the beginning of real, practical programmes to make joined up, person centred care a widespread reality.
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Cynics may raise the question: why should it be different this time?
First, the momentum comes from localities. Integration, though actively supported by the government, is not a government plan. The word did not appear in its massive Helath Bill until forced in by the voices of many stakeholders during the “listening pause”.
Just as localities threw themselves into the early creation of health and wellbeing boards, so they besieged the integration pioneer programme with applications − more than 100 − from about two thirds of local areas.
‘Very quickly, the new national health bodies and their weary, but tolerant, older siblings from local authority social care came together in a common purpose’
Both local authorities and local NHS bodies have been fully aware of the burning platform of constricted resources, growing demand and unsustainable patterns of care. They are well in advance of the current rash of calls to action and future commissions in knowing where and how provision must change.
Second, there is scale. Many pioneer areas have populations approaching 1 million − one has more than 2 million. Multiple clinical commissioning groups, provider trusts and local authorities are willing to step back together, look at their budgets as a whole (the local pound), and start again. This may finally power up the so far unconvincing commissioning paradigm.
Third, there is national unanimity. Very quickly, the new national health bodies and their weary, but tolerant, older siblings from local authority social care came together in a common purpose launched in May, promising to help local areas make their plans happen. The pioneers, and in turn other areas, should benefit from a dedicated support offer coordinated by NHS Improving Quality, with flexible permissions to bring down policy and financial barriers.
And fourth, and most significant, there is a real chance that this time, more than any other time, it is outcomes for the people who use services that will determine the content of these programmes.
The narrative National Voices coproduced with service users and their organisations, working with national system leaders and aligning with Think Local Act Personal’s Making it Real personalisation initiative, has spread with alacrity.
These two sets of user statements are being actively used, by the pioneers and others, to shape their common vision and purpose, identify key outcomes and derive measures of progress.
Therefore in England, integration − described in research reviews as a “hodgepodge concept” with more than 175 varying definitions in the literature − is being redefined from the service user perspective as “person centred coordinated care”.
When people say: “I want to plan my care with people who understand me and my carers; “I tell my story once”; “I have a single point of contact”; “I know what to do when things change.” These aspirations are being adopted and secured by their care commissioners and providers.
Before we cheer, however, it is worth noting the two main dangers ahead.
The first is political. The government has carefully supported and nudged these developments. It must resist the temptation − apparently still present, despite its own reforms having put the NHS at arm’s length − to keep throwing new initiatives and objectives across the bows of this accelerating vessel.
‘Unless people are genuinely empowered to manage their lives and conditions, and direct the care and support they need, the anticipated gains will not materialise’
For its part, the opposition, in fleshing out its vision of whole person care, should beware of reassigning functions and responsibilities around local systems that have effectively already decided to pool them and move forwards.
The second risk is “skin deep” personalisation. Service users do not want “coordinated care” without its “person centred” components. Unless people are genuinely empowered to manage their lives and conditions, and direct the care and support they need, the anticipated gains – including system sustainability – will not materialise.
Pioneers, and all the other localities drawing up their coordinated care plans this winter, need to ensure that personalisation runs through their redesigned services like a name through a stick of rock. National Voices and Think Local Act Personal will support and challenge them along the way.
Don Redding is director of policy at National Voices