How can councils play a leading role in integrating care?

September 07, 2018

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If the case for integrated care is to resonate, you need to be absolutely clear about the problem you are trying to solve and the future state you are trying to achieve. We know from our Local State We’re In survey that 81% of local government leaders and chief executives believe that integration will have a positive impact on health outcomes. Councils have a unique and critical role in making this happen, but do they have the desire to lead the change that is needed?

Our work across the country has identified a common set of challenges to integrating care that no single organisation can address in isolation:

  • Commissioning is fragmented across multiple organisations and many separate arrangements
  • Contracting is usually for activity rather than outcomes
  • Rising demand is outstripping the funds available
  • Provision is divided between multiple providers each seeking to remain financially sustainable
  • Providers are under pressure to fulfil national targets and avoid unwanted attention from regulators
  • The public experience a reactive health and care system, with a patchwork of providers, multiple hand-offs, delays and a treatment orientated culture.

So what does good look like? The opposite of the above! In the long term, fundamental changes are needed to the health and social care architecture and how money flows around the system. However, councils have a lot to bring to the table if they are willing to work with the multiple organisations involved and drive change.

The building blocks of integrated health and social care start at neighbourhood level – bringing together the care professionals (GPs, community nurses, mental health and social workers) that help to keep people well, and supported in their community. Add in local authorities’ connections in the community, their focus on information, advice and guidance and a ‘social work mindset’ of ‘how can we help you to help yourself?’ and there is much that can be achieved.

Good integrated health and care systems are simple to navigate for the public and professionals alike.  In an ideal system, there is one point of access, staff all know what’s available within the system to support a person in need, and care pathways are navigable and start with support to remain healthy and independent.

If we look at how councils have got through the last nine years of austerity, most have made improvements based on their own services’ perspective. Contact centres funnel requests for support and triage, digital platforms enable self-service, the default first intervention is to support people in their own homes rather than in institutions, and personal budgets enable choice and flexibility to self-support. How can these experiences be further brought to bear into the health and care system?

Delivering operational change requires enlightened commissioners, providers and system leaders. Councils are in a unique position, acting as both commissioners and providers, with democratically elected leadership to represent the voice of citizens and Health & Wellbeing Boards to bring the system together.

However, to transform, you need a keen understanding of what’s wrong with the current system, a vision that is different from the past, the ability to bring together a coalition of the willing, and, importantly, the desire to lead.  

To paraphrase JFK – ‘ask not what your health and care system can do for you, ask what you can do for your health and care system’.  The future health and wellbeing of the people in your area may depend upon it.

Mike Wallace  | Director
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