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The goal of seamless care integration

Source: PSE Aug/ Sep 16

David Stevenson looks back at this year’s Health+Care Show, the largest national integrated care conference, and what challenges remain to delivering joined-up health and social care.

This year’s Health+Care Show took place in the shadow of the UK’s vote to leave the EU, and just days before the NHS-led sustainability and transformation plans (STPs) were due to be submitted. 

Unsurprisingly then, the UK’s largest integrated care show, of which PSE was the official media partner, was a hotbed of discussion and debate on these topics and how to deliver truly seamless and inter-connected services. 

Place-based approaches 

Early on the first day, Debbie Sorkin, national director of systems leadership at The Leadership Centre, took to the Local Authority Theatre stage explaining how a place-based approach is essential for delivering integrated care. 

However, Sorkin added that commissioners and providers shouldn’t try to change everything at once, instead advocating that “small solutions can build to big success”. 

For the first time ever at Health+Care, the Commissioning Show was fully incorporated into the conference. During an early presentation Sir Muir Gray, director of Better Value Healthcare, who is a veteran of 20-plus structural reorganisations of the NHS, said that while integrated care is a “laudable initiative” it is better to look at the population served as opposed to the bureaucracies that need to be integrated. 

“Health and healthcare problems are complex or non-linear and, therefore, cannot be solved by linear organisations, important though they are,” he said. “What is needed is to develop the other two bits of its organisation – its systems and its culture.

For the future, therefore, we need to think of population and personalised healthcare.” 

Early Vanguard work 

Sharon Blackburn CBE, policy and communications director at the National Care Forum, told the audience that if we can get the under-pressure social care sector right, it will help the situation within health. 

However, she noted that a public conversation still needs to be had, as many people do not realise social care is means-tested. 

Blackburn added that simple solutions are there to address integration barriers, suggesting that people should look at the early work of the Vanguards. 

Jacob West, NHS England’s national lead for primary and acute care systems in the New Models Care programme, said that one of the goals for all new models of care is to find the golden thread of replicable public health. 

He also highlighted different examples of innovations being taken forward by Vanguards, including Symphony Programme’s enhanced primary care model using health coaches and creating parity of esteem between GPs and other partners; Morecambe Bay’s grassroots Millom campaign, aimed to help recruit GPs to the geographically isolated town; and the acceleration of data and IT in care homes, with Airedale & Partners, for example, developing a secure video link that connects care home staff to specialist hospital nurses.

Integration should not be visible 

During a session on co-producing a new community mental health and wellbeing service, Emma Hanson, head of strategic commissioning community support at Kent County Council, said that in order to deliver improved services mental health leaders must work with other leaders in the health economy. 

She also noted that the sector still needs to get its head round how it pays for outcomes to incentivise providers and get good value for money, “as big isn’t necessarily better...and cheaper isn’t always best value”. 

During a lively session on what integrated care actually means, Prof Martin Green OBE, CEO of Care England, said that “if integration is working it should be invisible; as a citizen I don’t want to see the joins”. 

He added there must be a focus on giving people a life and not a series of services, and that patients are like aeroplane passengers: they don’t need to know how the systems work together, just that they do. 

Prof Green said that the STPs, which cover 44 footprints across England, must be about the whole system, not just health and social care, even though the Department of Health “too often returns to the medical model”.


A new vision of integrated public services 

Former health secretary Stephen Dorrell, now chair of the NHS Confederation, said that STPs should be used to deliver “a new vision” of integrated public services, with full local authority involvement. 

Dorrell, who is the independent chair of the Birmingham and Solihull STP board, which is one of just three in the country to have a leader from local government instead of the NHS, said that having a local authority lead in an STP “reduces the risk of the STP simply talking to itself”. 

Even Michael Macdonnell, NHS England’s director of strategy, said STP areas involving local government have been the strongest. 

However, a recent investigation by PSE revealed that Greater Manchester Combined Authority has had greater involvement in healthcare planning than other local authorities, suggesting that devolution is better than STPs at delivering integrated care.

Lord Andrew Lansley, the former health secretary, who ushered in the Health and Social Care Act 2012, which introduced substantial changes to the way the NHS in England was organised, discussed the impacts of Brexit, adding that the health and care sector needs to quickly set out its priorities from the new relationship with the EU. 

He added that the £350m figure the Leave campaign said would be reinvested in the NHS “was never remotely correct”, but we must now work to maintain and protect the best health research base in Europe. 

Adam Roberts from the Health Foundation noted that Brexit won’t mean more money for the NHS any time soon, and Andrea Sutcliffe, chief inspector of adult social care at the Care Quality Commission, added: “I am no economist but it feels unlikely to me that the current volatility will lead to an increase in public finances and a reduction on the pressure of social care budgets. Finances will continue to be tight and the pressures facing local authorities and providers will undoubtedly remain. 

“We have to ensure that in the midst of all this we retain our focus on ensuring people receive care that is high-quality, effective, compassionate and responsive to their needs.” 

Integrating mental health 

During the two-day show, which took place at London’s ExCeL, former care minister Norman Lamb MP, chair of the West Midlands Commission on Mental Health, explained why reforming mental health is vital to the West Midlands Devo Plan. 

He recommended a multi-agency, holistic approach and ambitious targets for the West Midlands Combined Authority, which could include commitments to no out of area mental health placements, no use of police custody, reducing the use of restraint and seclusion and diverting people from the criminal justice system. 

Lamb did note, though, that there is a danger of mental health services becoming further disadvantaged nationally unless a concerted effort is taken to deliver a holistic approach that places mental health at the heart of STPs.

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Learning lessons and future funding 

Other sessions looked at learning lessons from the collapse of the £880m UnitingCare contract. UnitingCare, an NHS consortium of Cambridgeshire and Peterborough NHS Foundation Trust with Cambridge University Hospitals NHS Foundation Trust, was named the preferred bidder in October 2014 to improve older people’s healthcare and adult community services in the region. 

Following the collapse of the contract, which suffered from widespread problems, NHS England said it is developing a new assurance framework to avoid future contracting failures. Julie Spence OBE, chair of Cambridgeshire and Peterborough NHS Foundation Trust, told Health+Care delegates: “The UnitingCare contract was the biggest waste of money and loss of potential I have witnessed in my 38 years of public service.” 

Margaret Wilcox, vice-president of the Association of Directors of Adult Social Services (ADASS), noted that there needs to be a greater emphasis on transferring funding from acute to community and preventative care. As social care is facing an acute funding crisis, said Wilcox, it is imperative “to stop and reverse the reliance on acute care and redirect some of those resources into prevention and acute care”. 

While Wilcox welcomed the Spending Review, which allowed councils to levy a 2% social care precept on tax to cover social care costs, she said it was “too little too late, because we won’t see any of the real money by 2020, by which time we will have had five years of reductions”. She added that over the past five years social care budgets have been cut by 33%. 

The ADASS vice-president warned that one of the greatest challenges to delivering integrated care would be the mismatch in terms of funding, since healthcare is free at the point of delivery but social care is means-tested. 

Tom Jackson, chief finance officer and deputy chief officer at NHS Liverpool Clinical Commissioning Group, agreed that greater integration was needed, but added that STPs need to be “more ambitious” in integrating with social care. 

This year’s Health+Care conference was a great opportunity to discuss the progress being made to join up care, especially through the use of STPs and Vanguards. 

However, it was also very clear that we are still some way away from delivering “seamless” integrated care.  Perhaps at the next edition of the show, which takes place from 28-29 June 2017, we will see even further moves forward in this very complex area.

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