ERNST AND YOUNG
In this report, commissioned by the Local Government Association, a journey towards better health and care for individuals is set out; driven by local system leaders and supported by a more empowering and enabling system. The report has been developed through: a review of existing literature published by partners, charities and research organisations; four workshops with the LGA and partners to define the vision, understand the system barriers from a range of perspectives and describe the required changes; and further discussion with regional contacts and the Health Transformation Task Group to sense check that barriers and key considerations are locally relevant and reflect the experience in local areas. Section 1 sets out a vision for better care and support, arguing that a reformed system needs to deliver: better health and wellbeing more equally enjoyed; better choice and control for all; better quality care, tailored for each person; and better outcomes for each pound spent. Section 2 focuses on key barriers preventing the achievement of a reformed system. These include: creating dependency through the way treatment is provided; chronic underfunding of the system and a lack of capacity to transform; fragmented commissioning incentivising treatment over demand management; and national regulations that disempower local areas. Section 3 sets out four steps to better care, which are: put people in control; fund services adequately and in an aligned way; devolve power to join up care, support and wellbeing; and free the system from national constraints. The report concludes that collectively these steps will enable localities to address challenges, deliver a better system and ultimately drive better outcomes and greater sustainability for all.
The importance of health, social care and other sectors working together has been recognised for many decades by governments of all political persuasion. This is true within the current policy environment, in which integration has been proposed as the binding force to connect an increasingly diverse range of providers around individual patients and their families. Initiatives to promote integration are being introduced at all levels of the system, with a patient experience based narrative setting the standard against which success should be judged. This integration is being encouraged not only in respect of statutorily funded clinical, public health and social care services but also with other policy areas such as housing and leisure and other sectors (in particular the third sector). Despite this continued belief in policy that integration will lead to a more preventative focus, there is not a strong research base to support this view. However, accepting the limitations of the evidence base, this Policy Paper looks at five key lessons which can still be drawn for national policy makers with responsibility for promoting integration and prevention. These are to: start with what is fragmented; be clear what is meant (by integration); know what success looks like; understand the impact; and be wary of further change. The paper draws attention to key findings from reviews of integrated care; and notes that the interventions that have been most effective have been those with more preventative approaches. It concludes that patients and service users have to integrate support from statutory services, community resources and their personal networks to improve their quality of life and maintain their health and independence. To understand how and when to integrate, we first need to be clear what links are required and how they could operate in practice. That is why fragmentation rather than integration should be the starting point to achieve a prevention orientated health and social care system. This policy paper is based on a discussion paper which was commissioned by the Institute for Social Change at Manchester University as part of a series of Knowledge Exchange Trials workshops which brought together academics, policy makers and programme stakeholders to facilitate exchange of ideas, expertise and research.