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23.10.17

United we stand, divided we fall

David Pearson, Nottinghamshire County Council’s corporate director of adult social care and public health and the sustainability and transformation partnership (STP) lead for the region, argues that all bodies in the health and care sector need to learn to walk in each other’s shoes and work together effectively to bring about truly transformational change.

Local STPs have been described by the NHS as the ‘biggest national move to integrated care of any major western country,’ which is a bold but very true statement to make.

This is at a time when the two key players – the NHS and local councils providing social care services – are experiencing a rise in demand in services and tough financial challenges, making this new partnership approach an even bigger mountain to climb.

Much of the national media coverage on STPs has focused on hospital care, and some councils I’ve spoken to have not felt welcome in the early stages to contribute as much as they could with their joint plans.

However, social care, public health and wider local government is not playing a supporting part as it has such a large role to ensure that people receive the right care and treatment at the right time and stay at home for as long as possible.

Equal partners

As the only serving director of adult social care leading a local STP, I believe local authorities need to have equal billing with the NHS to ensure we make a difference to the communities we serve.

This is an ambitious mission considering the differing policy drivers of both sectors.

After all, the NHS is nationally accountable through its mandate from Parliament and government, whilst councils are accountable to local politicians and residents.

Furthermore, policies, systems and cultures on both sides have developed separately over decades, so effective integration and collaboration is the only way for us to transform the way we work in the 21st century – and this will take time.

From the Nottinghamshire perspective

In Nottinghamshire we have consciously identified our ‘fourth gap’ as culture. From my perspective, I spend half of my time focused on the organisation I work for and half my time on making the whole system work to help bridge this gap.

In the region, I can see that a sense of shared enterprise is making real inroads with services.

Patient discharge delays have reduced by a third in the first three months to May this year compared to the same period last year, which is the biggest improvement in the country and has been recognised by the health secretary.

Likewise, our ambitious plans to improve the way councils and the NHS share information is already helping to prevent unnecessary hospital and care home admissions, along with offering patients a quicker and smoother transfer from hospital.

Furthermore, our pilot schemes linking up health, social care and housing are proving successful in giving people more consistent care from home for as long as possible, which is what our communities are telling us they want.

The good, the bad and the ugly

This is not to say there have not been tensions of late, in particular relating to the national arrangements for the Improved Better Care Fund, but this is not surprising given the challenges being grappled with.

Transparency and good communication is vital during difficult times and all partners need to share the good, the bad and the ugly, including difficult conversations about important issues – otherwise we are not doing our jobs properly.

Parties must also learn to walk in each other’s shoes and have respect for all organisations’ responsibilities and ambitions whilst meeting the priorities of their own organisation. The prize for our communities is great, and everyone must stick with it.

Top Image: xijian

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