The key things every councillor should know about the Better Care Fund was a topic explored at one of the micro-surgeries at last week’s LC Summit. Run by PPL, the surgery offered advice on how to get the most out of working in partnership with the NHS.
1. Successful integration is about trust
In the past, people have tried to develop better systems of health and care from forests of organisational strategies, governance, spreadsheets and analysis. These all have their place. But without local communities that understand and are engaged in the changes proposed; professionals, who believe it is the right thing to do; and partners, who are prepared jointly to weather the invariable storms ahead; no amount of process or structure will deliver better outcomes on the ground.
Improved health and wellbeing comes not from pyramids of risks and benefits, but from pyramids of trust, with clarity and honesty at every level. Councillors have a key leadership role to play in engaging at all levels, to ensure that local resources are being successfully pooled where it makes sense to do so, and that local communities are fully engaged in this process of change.
2. The NHS and Local Government are more similar and more different than we think
Since 1948, the NHS and Local Authorities have been working side-by-side to improve the lives of people across the UK. Many of the challenges we now face are a product of their successes – transforming people’s health and wellbeing, and raising expectations at every stage of life. It doesn’t take much time spent in either environment to recognise that the drivers, culture and practices within health and local government are very different. Taking time to understand these differences, where they come from and what they mean for the future, is key to building effectively integrated services. This matters, because both health and care services are under unprecedented pressure. The most important thing both share are the communities they work to support; and in this, they will succeed or fail together.
3. This is about ensuring Mrs Smith gets the care she deserves
“Mrs Smith” lives in Torbay and helped to start a revolution in the way local health and care services were delivered. Across the country, there are millions of people like Mrs Smith who need support to live independently and well. When we fail her, it is not just Mrs Smith that suffers, but our local health and care economy as a whole. Mrs Smith is your constituent, and she belongs to the voting generation, but that is not why she is important. She needs you to represent her for one reason only - because you do not need to know Mrs Smith, to know and care for someone just like her.
4. There is no one-size fits all model, but nowhere are we starting from scratch
Localities across England are in the process of developing and implementing plans for integrating services to deliver better co-ordinated, person-centred care; not simply because it’s what people want, but because it’s one of the few ways we have to improve the way we manage demand across the health and care economy. Every area is different, reflecting different local priorities, capabilities and needs. Nonetheless, there are a number of common challenges – including how best to engage service users and professionals; how to plan care in a way that genuinely transforms outcomes; how to share related information safely and responsibly; and how to ensure there are services in place to deliver high quality, sustainable care. Increasingly, there is a body of emerging best-practice that shows these challenges can be overcome.
5. This will not happen without you
Debates about integrated care can easily get lost in the latest policy or set of initiatives around health and social care. Fundamentally, this is about working in a joined-up way to deliver better quality outcomes for local people. You don’t need to be an expert in the social-economic determinants of health and wellbeing, to know that helping people to live more healthy, independent and better lives is about far more than the medical model, or what our limited resources for social care can achieve.
This is about recognising that many of the disconnects occur not just between health and local government, but within the different services that each offer; and that taking a person-centred, co-ordinated view is as much about transforming the way that council services work with each other, as it is about changing the way that we work with colleagues in health.
PPL is an independent, specialist consultancy, based in London and working on practical projects promoting health and wellbeing across the UK. www.pplconsulting.co.uk