The Labour Government’s message is simple: improve the nation’s health by delivering better and more preventative care closer to where people live their lives, improving their experiences of services and ensuring their contribution to a prosperous, growing economy.
This is what the Secretary of State Wes Streeting’s ‘three shifts’ aim to achieve, and what next year’s 10 Year Plan for Health will seek to set in motion.
Naturally, there are differing views about how to achieve this, but system leaders of all backgrounds are clear: turbocharging the integration of health and care services at ‘place’ is crucial.
Summarised in a new report, the NHS Confederation has spent six months interviewing more than 60 leaders from systems – including ICB chairs and chief executives, integrated care partnership chairs and leaders from local authorities, the charity sector, acute trusts, primary care and other stakeholders – to understand what integration at ‘place’ is, why it is important and what it means in the context of systems and neighbourhoods. The findings, look at how integration at ‘place’ is delivering on system ambitions, and what the government can do to better enable integration at ‘place’.
What we heard was that, at a time when significant challenges face our public services, most recently detailed in Lord Darzi’s investigation of the NHS in England, a focus on the places that matter to people and communities offers a path forward. Bringing together all the organisations and the multiple budgets they hold that impact a local population’s health and wellbeing to work more closely is paramount to achieving this. This is integration at place.
Our research is clear that place – most commonly a sub-ICS geographical scale typically aligned to council geographies – is often the scale where system integration is best delivered. Place can often offer the biggest gains in tackling inequalities, delivering more proactive, preventative care, delivering a neighbourhood health service, and contributing to social and economic development.
Integration at place can help to tackle both the short- and long-term pressures facing the sector and deliver meaningful improvements to people’s experiences of health and care by planning and delivering services more closely with local communities.
Our report, for example, highlights a frailty hub in York where local partners have worked together to successfully reduce the number of frail patients in acute care and decrease ambulance callouts by over 100 per month.
NHS and local government partners are working together in Hinckley and Bosworth to deliver a project focused on reducing damp and mould in homes to improve outcomes for residents living in affected conditions. The project is addressing housing barriers to successful hospital discharge, reducing readmission rates, and promoting overall wellbeing.
Delivering this, however, is not easy and local leaders often come up against many obstacles in their path. The challenging financial and operational environment in both the NHS and local government is not only restricting place integration in some areas but, in many cases, actively undoing it. This is because a national emphasis on getting a stronger grip on the financial pressures in the NHS has led to command-and-control behaviours trickling down into the system from the top, and the running cost allowance reductions asked of ICBs have had a restricting effect on place level teams affected.
The leaders we spoke to suggested that successfully delivering integration at place requires an approach that is led by local partners coalescing around a specific, local issue (not when the model is imposed upon them), adopting an approach that is inclusive of all partners with genuine parity of decision-making.
While much of this is new to colleagues in the NHS, working in this way is not new to local government. Working at place is, by definition, what local government does. What we heard from our research is that local leaders must seek to bring in partners as early in the process as possible, learn from what others have done already, and build on what exists.
Although integration at place requires local partnerships to grow, the government’s 10-Year Plan for Health can accelerate it. Namely, by putting integration at place at the heart of the plan; recognising and resourcing the move to more place and neighbourhood working as one of the biggest change programmes in the sector’s history; and by recognising and enabling the risk and disruption that leaders must inevitably manage with these shifts.
We also heard that renewing a programme like the previous Labour Government’s ‘Total Place’ policy programme can help to change incentives about how the public pound at ‘place’ delivers better outcomes for the public.
We recognise that this is not going to be easy when places do not have statutory status like ICBs or local authorities. However, for local leaders to be brave in realising the government’s ambition, the government must itself be brave by putting integration at place at the heart of its forthcoming plan.
