I am writing this blog in the middle of the early September heatwave but, as lovely as it is, my thoughts were drawn to Winter because, as sure as Santa is coming, there will be a crisis in the NHS (or more specifically hospitals) which will raise the spectre of bed blocking by Councils, and a lack of social care!

For those of us who work in local government and the NHS, this is an annual, unenlightened event that for a brief period puts the co-dependence of the two systems into the public eye in the most unhelpful way.

Why? Because it frames the relationship in a negative light, casts the purpose of social care as primarily a hospital discharge system and, reduces the NHS to only being about hospitals and A&E.  Although my career has been almost exclusively in local government over the past 15 years, I’ve spent huge amounts of time working across the two systems to change that narrative and reality, to one which is much more positive, constructive and makes a real difference to people’s lives.

So, taking a step back from the blame game of mid-January, why, and how, should we lead a debate and movement to focus on something very different? The best local authorities, NHS trusts, and systems, know resident and population interest’s are best served by creating strategic partnerships and integration that exists at two different levels:

  • Strategically, population health and outcomes won’t improve to benefit individuals, communities, or institutions via a reduction in demand without long-term joint planning. Planning will reduce health inequalities, improve the quality of life for residents and improve access to services. Everyone knows this but, how many ICP’s and Borough’s are actively developing detailed strategies and action plans to make this happen? Leaders should be prioritising this urgently given the time it takes to make an impact.
  • Health and Social Care systems are hideously fragmented. While the advent of ICS’s are a step in the right policy direction, leaders need to decide that their task is to create a citizen facing “service”. This service should be made up of all of the multitude of fragmented parts that operate in a way which ignores organisational boundaries. They should concentrate on applying a collaborative approach to stopping people become unwell and aiding their recovery when they do – it might free some beds up too!

Tragically, too few organisations and systems are sufficiently focussed on the above as a key priority. The reasons why are complex. They range from the top down target based systems of both the NHS and Local Government which reinforce silos; a lack of understanding; mistrust at political, board and professional level; and reinforcing organisational objectives rather than community and system objectives.

Of course, I oversimplify, but this is a blog after all and one I wrote, in part, to explain why I have chosen to join PPL as a Senior Advisor. PPL believe, as passionately as I do, in what Leaders in NHS and local government should be doing via partnerships and integration. They should work together collectively to tackle both the long-term challenges of health inequalities, and the shorter-term issues that are holding back better integration of services to improve citizen experiences and outcomes right now.

Moving an organisation, and particularly a system, towards the objectives I outline is neither quick nor straightforward but, there are several practical steps that can be taken to move forward:

  • Generating commitment and understanding at Leadership level of the benefits and outcomes that can be delivered by improved partnership and integration – this should be, but is often not, a given, because there is huge ignorance on all sides about the context and pressures under which the other operates.
  • Therefore, creating the conditions to enable a greater understanding of the objectives and priorities of different elements of the system, allowing for collaborative solutions to be developed, is crucially important – time spent on this will reap many rewards!
  • Taking action, by developing a shared strategy and plan collectively that recognises both the changes and actions that need to take place over a short, medium and long-term to make it happen – without this we will have improved relationships but not improved outcomes.
  • Prioritise, resource, and performance manage the delivery of the plan and ensure there is sufficient capacity to make it happen.

I have been involved in boroughs and systems noticeably in Greater Manchester and North West London where leaders have recognised the importance of addressing the challenges I raise here. I would encourage all councils, NHS organisations, and systems to consider to what extent they are prioritising these issues and just as importantly assessing the internal capacity and external support that they may need both to improve relationships, understanding and joint working to make the change happen.

Winter is sadly coming, and with it the annual crisis I highlight. While there are many elements that need to change to address this, not least more resources, capacity, and people to meet the demand, it is also the case that parallel system leaders need to look to how, over time, we can bring organisations together to tackle the underlying challenges of health inequality, and work to make the system better in how it delivers at ICS, Borough and Neighbourhood Level.

Written by Sean Harriss, PPL Senior Advisor