Integration and innovation and health and care

Featured article - 24 May 2018
By SCIE's Ewan King, director of business development and delivery

Head-shot of the author, SCIE's Ewan King, director of business development and delivery

This blog is taken from a speech by Ewan made at an Institute for Health Management event in May 2018.

One of my key principles is the full integration of health and social care centred around the person. We know that when this happens people stay longer at home, healthier, more independent - and needing fewer hospital services

Jeremy Hunt, Health and Social Care Secretary, discussing what needs to be in the upcoming social care green paper.

What are the features of the best practice models of care that are integrated around then person and maintain people's wellbeing and independence? And how can we scale up what works so that a larger population can benefit from good integrated care?

Model behaviour

Many of the models we have looked at seek to harness the skills, capabilities and resources of people and their local communities, and bring these together with statutory services to give people more holistic forms of support. Essex Village Agents, a collaboration between the council and the voluntary sector, builds support, information and contact around people. It operates on a strengths-based (assets-based) model, focussing on what people bring - their skills, resources and networks - rather than their problems. It helps people find better, solutions, and draws less on state solutions.

Can we talk?

Good models should start with a conversation, not an assessment. The best integrated models, such as Age UK’s Personalised Care Programme, which is delivered by a combination of volunteers and professionals, starts by focusing on what people want to achieve and then looks holistically at needs. The process begins with a conversation between the person and the voluntary sector coordinator, who helps them to identify their goals and coordinate a management plan. Trained volunteers provide support to help the individual become better connected to their community, be more physically and socially active and subsequently have better health outcomes.

Co-production and co-design

People who use services are often the best commentators on how they can be improved. They are the experts. Some of the best examples of integrated care arise from joint development and design, with the citizens who use them. National Voices' Wellbeing Our Way programme aims to develop the ways in which charities and community organisations enable people to manage their health in ways which matter to them. In particular, the scheme aims to enable people to be active in managing their health and working towards their personal goals.

Relationships not structures

At the heart of these models are good relationships, between GPs, social workers, volunteers, hospital staff and housing. So in the Sutton Enhanced Health in Care Home (EHCH) Vanguard, which SCIE evaluated, a great deal of focus was placed on joint training of staff, co-location and integration of professional teams as a way of building a better offer. Yes joint budgets help, and unified leadership, but more than anything it needs to about culture change and joint working.

Scaling up preventative, integrated care

Whilst we increasingly understand what good looks like, we are less good at bringing these examples to scale – so that more can benefit from them. This was the question we tried to ask through a recent study we undertook with the innovation foundation, Nesta. We concluded that the sector needs to restate and recommit to a shared ambition to embed person-centred and community-centred ways of working across the system, using the best evidence. Because if we do this, we are more likely to follow through and commit to the kinds of changes that need to happen.

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