'Islands in the stream, that is what we are, no one in between, how can we be wrong?' - What is place based change and what is its potential?

03 July 2018

Russell Jones, Consultant

“It was the best of times, it was the worst of times […] it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us[.]”

Although in 1859 Dickens might never have envisioned his famous quote would be relevant to local public services 150 years later, I am hard pressed to find a more apt summary of where we stand in 2018. From austerity and Brexit to homelessness and the hostile environment, from isolation to insecurity, the challenges for public servants seeking to improve lives and life chances have never been greater. Nor have the opportunities for local government and communities to step up been more important.

We stand at a cross roads with crises in public finance, democracy, and trust in institutions. There are fundamental questions we must ask about what relationships citizens want with the state (at local and national level), our expectations of the state, and the social contract that underpins this. Unlike almost any other time in the post-war period, however, central government will not be leading the charge with answers. With a slim majority and diminished capacity due to Brexit, there will be no top down answers coming from Whitehall any time soon – just look at delays in the Social Care Green Paper.

Local areas must therefore seize the moment and do what local government is best placed to do – work with local people and partners to chart a new path toward a better local future. This will require bravery and honesty, working to underpin change with citizens within the art of the possible. Take comfort, though, in knowing it is possible. Take, for example, Wigan Council which is transforming its relationship with its community through the Wigan Deal.


Work on the deal started in 2011 and has subsequently supported a wholescale transformation with savings of over £100m and a 50% increase in resident satisfaction with the Council. Alongside financial improvements and improvement in resident satisfaction, the Deal has significantly improved staff morale – with Wigan being the only local authority in the country to rank in the top quartile of the Times Best Companies to Work For ‘Ones To Watch’ List. Through the Deal, the Council are working in partnership with local people and partners not only to face its biggest challenges around demand and resource (challenges facing local authorities across the country) but also to create a place fit for the future, that people are proud of.

At PPL, we are passionate about supporting positive change and strongly believe in the potential for place based change underpinned by local leadership. If you share our passion and want to take that next step, we want to hear from you. After all, as Dickens says, we still have everything before us.

Jose Acuyo Cespedes, Analyst

ScenarioJoel is 75 years old, lives alone in the outskirts of a town and has heard about a new hobby-discovery service in the next town available to those aged 65 or over. Enthused by the news, he goes to his local bus stop only to find that no direct buses run to the service-centre. Joel is not well enough to walk a long distance to the next town and so he stays at home alone. Whose fault is this? The service provider? The local authority? The transport provider?

As our understanding of health systems becomes more sophisticated over time, and as new research comes to light, we are starting to realise that the health of an individual person is not only down to the healthcare system. The Dahlgren-Whitehead rainbow (see below) shows us just how many factors contribute to the health of our population – ranging from health services to education to housing. We then have to ask, if so many factors impact on population health, why are they all working within their own separate kingdoms? The answer? Introducing place-based care: a world in which services revolve around local population needs to produce better outcomes.


So, what is place-based care?

Place-based care is the concept of different local organisations, including but not limited to health and social care, working together to improve the health of the local population, all whilst remaining financially sustainable.

This concept aligns closely with the new ‘Integrated care systems’ (ICS) which are currently being implemented across England. ICS will see health commissioners and providers collaborate with local authorities and other partners to take a shared responsibility for their local population. The ultimate aims of these systems are to keep the population healthier, in their own communities and out of acute services, thus being financially and operationally sustainable.

Scenario - So what does place-based care mean for Joel? It means that the hobby-discovery service provider will have worked alongside the transport provider and realised that they both have a significant role to play in keeping Joel healthy. Since they have shared outcomes, they will have realised that access to services is just as important as the service itself, resulting in Joel having easier access to the services he benefits from.

By beginning to roll out the new ICS across parts of the country, the message being sent by the NHS and local government is clear - collective action across organisations presents a real opportunity to improve population health by addressing the wider determinants of health.

Joel’s story is a small example of how place-based care can personalise services and improve user experience, thus improving health outcomes. Expanding this policy across the country provides a real opportunity to drive sustainable change and realising the vision set out in the NHS five year forward view: patients gaining control of their own care and breaking down the barriers in how care is provided.