To realise the plan’s vision of integrated care, the best innovations within local systems need to be scaled up, says Paul Burstow
So, we have a long-term plan for the NHS. There’s a lot to welcome, especially in mental health.
Yet to succeed in its ambition for a shift towards population health and integrated care, the plan requires new ways of working to be adopted and scaled quickly.
And it requires a sustained commitment and shared purpose within the NHS and between the NHS, local government, community and voluntary sectors, housing; and many others.
You could say that all of this has been discussed many times before. The prize is the smoother integration between all the institutions named above.
But that’s been knocked about for years. Critics might suggest we’re stuck in a “reform cycle”. So how can it be different this time?
Well, by looking at the best innovations and scaling them up, within local systems that embrace and encourage integrated leadership and multidisciplinary teams, very real change could be in the air.
Integrated care systems can bring together local organisations to redesign care and also improve population health.
In Frimley, having a cohesive system (including non-obvious organisations such as the ambulance service, pharmacists and psychology) has seen reduced admissions to hospital from care homes and reduced length of stays in hospital by care home residents.
And on the other side of the coin – the “outcomes” side – care home admissions have been reduced, as have GP referrals to hospital.
To succeed in its ambition for a shift towards population health and integrated care, the plan requires new ways of working to be adopted and scaled quickly
Of course there’s more to do, so systems leaders in Frimley say that the next step on the journey is to build stronger strategic links to the voluntary and community sector.
But the creation of multiple, expanded community multidisciplinary teams, aligned with new primary care networks, based on neighbouring GP practices, is a positive sign, and reflects the emerging evidence.
So, in Islington, technology has been harnessed to enable a broad range of professionals, based in different buildings, to connect and decide on how to support patients, leading to reductions in accident and emergency attendances.
Scaling up innovation
Systems leadership also sees professionals being willing to compromise, to “share power” and to being willing to work differently, using a clear outcome focus, joint training and team development. It can be a painful and challenging cultural shift, but that’s why it might just work this time.
And talking of cultural change, chapter one of the plan paints a picture of rejuvenated primary and community care working with social care, the community/voluntary sector and housing, to offer a more predictive, proactive and preventive model of care.
To succeed in many places, it will require the seeding and growth of a host of non-traditional asset-based ways of working. It will also require a serious investment in social infrastructure.
The challenge is still considerable. Funding to commission new services is limited; there is a shortage of the entrepreneurial leaders who need to drive innovation; and the evidence base is poorly understood and fails to always convince commissioners.
Funding to commission new services is limited; there is a shortage of the entrepreneurial leaders who need to drive innovation; and the evidence base is poorly understood and fails to always convince commissioners
It can be suggested that what is required is transformation, not endless testing. The Social Care Institute for Excellence has amassed plenty of evidence of what works.
What we already know is good enough to start scaling the often not so new, “new” models of care. Earlier this month we launched an Innovation Network, funded by the Department of Health and Social Care.
The network includes Think Local, Act Personal and Shared Lives Plus. Our goal is to bring together a combination of innovative providers, commissioners and citizens to support each other to spread and scale new ways of working.
The network will explore the barriers and solutions that will help scale innovative, person-centred, and community-based models of care so that many more people can benefit from them.
Models like Age UK’s Living Well initiative uses local volunteers and community networks to wrap health, care and support around frail older people.
Or Shared Lives, which connects loving family carers to people who need a place to live and some support. Or North London Cares, which brings together isolated older people together with young professionals to share experiences.
Over the coming months, we will develop and share useful information, and bring more innovators into the network. So watch this space.
If we can get this right the prize, of smoother integration, is huge.