New organisational forms, planned and developed locally, will help to make integrated care the norm argues John Copps.
As a test bed for new models, vanguards will play a central role in determining the shape of integrated healthcare over the years to come. In many ways, they are the crystal ball for gazing at the future of the NHS.
We have just passed the two years anniversary of the launch of the programme, and there’s already much to celebrate. But the challenge is quickly moving to how to translate local examples of innovative practice into something that will work nationally, at greater scale. As Samantha Jones, outgoing director of the programme, argued recently, we now need to ‘make “new” care models the norm’.
How to make a success story
So how do we go about doing that? What can we do to help the models pioneered by vanguards succeed elsewhere?
Organisational forms need to balance freedom to innovate with strong governance and accountability
A key enabler is having the right organisational structures needed to support integrated health and social care. Earlier in the year, NHS Improvement published a series of options for what organisational form providers might adopt to deliver the Multispeciality Community Provider contract, whose ambition is to move specialist care out of hospitals into the community.
The scenarios were billed as “illustrative”, and included a joint venture between GPs and local foundation trust.
As the NHS vanguard programme has shown, creating the space for innovation requires a change in how all partners in the system do business. Organisational forms need to balance freedom to innovate with strong governance and accountability. They must be able to bind together different parts of the NHS and social care jigsaw, giving everyone a stake in success and encouraging whole system thinking.
There is already spectrum of “non-traditional” organisational forms that allow NHS and social care services to do things differently. They include companies wholly owned by the public sector, joint ventures and social enterprises.
In children’s social care, for example, Achieving for Children is a joint venture between the London boroughs of Kingston and Richmond delivering a suite of integrated services under contract. Working with central government and forging relationships with local health partners, it is now working in neighbouring councils to spread its innovative practice.
Its model is designed to be scalable and it is in the process of incorporating Windsor and Maidenhead children’s services within a group structure.
Vehicles for delivering integrated care
Elsewhere, The Health and Wellbeing Limited Liability Partnership is a vehicle for delivering integrated health and social care services in the north of England. Comprised of nine social enterprises and charities, the LLP has been created to offer commissioners a single entity to provide services along entire service pathways and across a wide geographical area.
The NHS is already a diverse ecosystem of providers – but for new care models to fulfil their promise, it needs to get even more diverse
For the providers in the LLP, pooling resources gives them access to contracts from which they have previously been excluded. It also provides a vehicle for attracting funding, with the option of inviting investors to become a partner. For commissioners, one single point of contact for contract management and accountability reduces the cost of dealing with separate small providers, and the risk of financial failure is mitigated within the partnership structure.
A third example is Salford based Social adVentures, established in 2011, and a service user and staff owned not for profit company delivering public health services to the NHS and local council.
Since “spinning out” of the NHS, it has bought a garden centre, which it uses to provide meaningful activity for clients with mental health problems, and a nursery, which offers affordable childcare to local people (and generates a healthy surplus). Both these assets have been transferred from private to community ownership, allowing Social adVentures to provide a more integrated offer to local people.
These models, and others like them, can be a genuine addition to the public service family, maintaining what it means to be part of the NHS but bringing the disciplines associated with being an independent organisation. For vanguards, they can offer the conditions in which their innovations can grow from local projects to national influencers.
As always it’s the result that matter most, and organisation models must be designed to protect outcomes over the long term and “plumb in” appropriate governance controls. The mantra is “function before form” or, in other words, organisational form must always be servant to the outcome you want to achieve.
The Five Year Forward View demands radical thinking. The NHS is already a diverse ecosystem of providers – but for new care models to fulfil their promise, it needs to get even more diverse.
John Copps is a senior consultant at Mutual Ventures