The total transformation of care and support

Featured article - 08 May 2017
By Ewan King, SCIE director of business development and delivery

After a difficult winter for health and social care, thinking afresh about where we go next can feel like an exhausting prospect. How will we find the time? Who needs to be involved in shared conversations? What will be different this time around?

The Integration and Better Care Fund (BCF) Framework, published in April, states that: “The BCF offers a good opportunity to have shared conversations, and to consider ....how BCF plans can support the delivery of wider objectives and strategies around health and social care.”

• Integration and Better Care Fund Policy Framework 2017 to 2019
• Presentations from West Midlands Regional networking event, 27 April 2017

In the West Midlands, where last week I spoke to a Better Care Support Team supporting a regional network for those delivering integration, there was thankfully no shortage of people with great ideas and commitment to finding better ways to deliver health, care and support.

At the event I spoke about research SCIE had done with Birmingham Council, Shared Lives and consultants PPL on the total transformation of care and support. Published in January, this paper explores the potential to scale up the most promising examples of health, care and support services, providing examples of good practice and tools. With local areas tasked right now with developing visions for integrated care by 2020, and BCF plans for 2017-2019, I argued that this framework could provide some useful tools and prompts to help with this process.

• SCIE: the total transformation of care and support

In the paper we set out five ways to transform care which range from preventative care through to care for those with more complex needs. In relation to each we provide promising and evidence-based examples of care. Using real data from Birmingham, we modelled six of these models so that they were provided to the optimum number of people and looked at the cost and outcomes. What it showed is better outcomes and £9m savings.

How can this research help local areas as they develop plans?

In the paper we argue that plans need to be developed with people who use services, an argument which is mirrored in the Five Year Forward View. So firstly it provides a set of ideas - and a template to follow - about how you involve citizens in co-producing a vision and goals for integrated care.

Secondly, it provides a series of evidence based prompts - the five ways for reforming care - which can guide how you conduct your planning and ensure that they take account of the needs of the whole system.

Thirdly, it provides examples of good practice with the evidence-base underpinning them. So if you are wanting to adopt the best models of preventative, integrated care that helps people feel supported at home, there are models like Age UK's Living Well service you can look at.

Finally, it provides a framework for how you explore the potential - through economic modelling - for scaling up the most promising examples of initiatives to their optimum. This is helpful for those developing business cases to go into Better Care Fund plans.

Is it impactful?

At the end of my presentation I was asked the question, 'Do we have enough evidence of the impact of integrated care'?

I told the audience that we will never have all the evidence we need, but we have good enough evidence to do better things with health and social care services. It's never easy, but we do have to better use what we have got.