Building a sustainable future
for health and social care
The aim of this report was to present a new model for integration and innovation in health and social care that uses collaboration to create a unified, cross sector strategy to estates and infrastructure as the catalyst to meet the current financial and service demand challenges.
The model is not intended to be a “one size fits all” solution, in fact it is very firmly based within the context and opportunities provided by devolution and the need to recognise that place and people must be determinants of future sustainability.
The model has been developed from a review of the key barriers to change across system, financial, outcomes, workforce and infrastructure levels for the health and social care system.
The process for developing the model has been informed by a wide range of expert stakeholders from across the public, private and social sectors and includes new ways of working that demonstrates the power of collaboration, integration and innovation for improving lives, reducing costs and raising quality and outcome thresholds.
Whole systems leadership can provide a sustainable future for health and social care.
MAJOR BARRIERS IDENTIFIED
- the perceived failures at past attempts to reform health and social care;
- political and public fears about the perceived encroachment of private sector interests in health and social care delivery and antipathy or distrust of public and private partnerships;
- workforce development and skills gaps, in particular the need to equip staff with the competencies to deliver new ways of working;
- failure to adequately engage and involve patients, service users and the public in the process of change and development so that they feel able to participate in decision making;
- inappropriateÂ or outdated business models and regulatory frameworks that do not meet the changing patterns of demands and needs for services.
ENABLERS FOR CHANGE
- Estates and facilities: making the infrastructure and locations for service delivery cost effective and fit for purpose.
- Workforce removing professional barriers to promote joint working and enable whole system practitioner and leadership development;
- Financial integration of health and social care budgets;
- Systems reset rejuvenating the way in which health and social care systems are currently governed, structured, organised and inspected;
- Collaboration needs to be strengthened between national and local leaders including between the NHS and local authorities and between the Department of Health and the Department for Communities and Local Government.
- Financial accountability and budgets for health and social care need to be aligned as part of a unified system under the direction and control of a single government department. This could potentially be through a new department for communities and wellbeing. In addition, Cabinet level collaboration needs to be facilitated through the use of shared funding arrangements as part of a common pooled resource for health and social care. This needs to be replicated at local levels through single commissioning authorities covering both local authority and health services.
- Collaboration between providers and commissioners needs to be supported through new legal frameworks such as alliance contracting. Alliance contracting provides a legal contracting framework that drives and incentivises collaboration rather than competition, based on a no dispute culture that provides parity for public private and social sector organisations: an Alliance Contract can provide this essential foundation.
- Whole system leadership is needed at executive and elected levels with political and executive decision making power over the whole system. An elected Mayor with powers beyond health and social care including policing, justice, skills, transport, economic regeneration and housing can bring unified budgets, coherence and democratic legitimacy to the system.
- This should sit within combined authority structures under the newly mandated powers for elected mayors and be replicated in cross sector Accountable Care Organisation frameworks. In order to realise this there needs to be support for both elected officials and officers so that they are able to work across systems and professional disciplines, able to task others and develop a multi skilled and competent workforce.
- Workforce development needs to aligned across health and social care taking account of the new apprenticeship levy system and using Competency Based Learning modules as part of a skills escalator.
- A distributed service delivery model is required based on the gradual development of multi-service hubs. These could be focused on specific care pathways or service user cohorts e.g. diabetes, dementia care etc. As these multi-service hubs are developed the local hospital provision can be adapted with the release of hospital estates as part of a joined up OPE strategy with local authority partners.
- Inspection and regulatory regimes need to aligned on an outcome basis at local rather than national levels.
- There needs to be national and local commitment to long term outcome commissioning beyond existing political horizons. This should include recognition that significant system change is being undertaken with longer timeframes for improvement according to the scale and pace of change e.g. over 5 and 10 year timeframes.
- Development of integrated health and social care services should include parity amongst partners from across the public, private and social sector with an explicit aim of using transformation in service models to help build the social sector.
- There needs to be acceptance and understanding across the system that willingness to innovate and make effective change means and learning from new ways of working and that in the process of change some things will work and some will not. To better support the process of change there needs to be resources for research and development including local area feasibility studies.
- Local change programmes need to harness the impact of digital innovation on services and outcomes as part of a strategic drive towards prevention and public health improvement.
- Local area change and transformation plans need to maximise the possibilities and potential provided by social investment to help drive transformation.
Professor Lord Patel
of Bradford OBE