Imagining a transformed health and care landscape

In our paper Total transformation of care and support we identified five areas where transformation is needed in health and care systems:

1. Helping people and families to stay well, connected to others and resilient when facing health or care needs
2. Supporting people and families who need help to carry on living well at home
3. Enabling people with support needs to do enjoyable and meaningful things during the day, or look for work
4. Developing new models of care for those who need accommodation as well as support in their community
5. Equipping people to regain independence following hospital or other forms of health care.

For each area, we also identified promising models of care, such as Shared Lives, Local Area Coordination and Age UK’s Living Well approach, and modelled the potential savings to the care system if we scaled them up. Based on financial modelling of cost savings from implementing the changes elsewhere, we concluded that implementing these models in Birmingham would generate cashable savings of £7.5 million per year within adult social care.

In Realising the value, Nesta and partners, including the Health Foundation, National Voices and PPL, looked at what it means to put people, families and communities at the heart of health and wellbeing, and the actions that national bodies and local areas can take to make this a reality.

In The asset-based area (TLAP, 2017) and Asset-based places (SCIE, 2017), we described how statutory services, working with communities, can develop asset-based areas which create the right conditions in which innovation can be fostered.

The question which follows is: what would a local health and care system look like were we able to create asset-based areas and scale up the most promising innovations? Such a system, in our view, would have the following features.

• People’s health, care and support shaped through strength-based conversations that seek to address a whole person’s life, rather just assessing a narrow set of needs
• Services are co-produced with the people whose lives they touch. This means that everyone involved identifies priorities, co-designs services and systems and works together wherever possible to co-deliver the work that takes place
• A flourishing range of community assets and peer networks focused on building the knowledge, skills and confidence of people to self-manage their care
• Neighbourhood-based multidisciplinary and integrated teams , working with communities and volunteers and focusing on what is important to each person. This can be done through personalised planning which aims to include all aspects of family and community life
• Budgets are devolved as far as possible down to neighbourhoods, families and individuals, maximising choice and control over how money is spent on people’s care
• Community buildings, including care homes and primary care centres, are reassigned as multi-use community resources
• Services are funded and measured on the basis that they make positive changes in people’s lives , in terms of wellbeing, resilience, independence, connections to others and the ability to self-care
• A thriving and sustainable voluntary, community and social enterprise sector , working alongside people, families, communities and the health and care system

These features of a transformed system are represented in the following map and stories.