Transforming Local Services
I’ve followed the health reforms pretty closely so I’m relatively up to speed.
But often, new ministers find themselves in departments where they know only the bare bones of the policy. And they’re expected to turn themselves into experts overnight.
I’ve been an MP long enough to hear my fair share of new ministers read out speeches in the Commons and clearly have absolutely no idea what they’re talking about. The crueller members of the opposition can sometimes make it a bit of a trial for them.
But the machinations of government can’t just creak to a halt as the new people find their way around. So new ministers rely on ever-present civil servants to guide them. They rely on ministers who haven’t been reshuffled to keep a hand on the tiller. And they rely on their fellow new ministers to be conscientious, decisive and creative about their own parts of the portfolio.
In other words, for reshuffles to work, every part of government needs to be supportive of all the other parts.
The same is true if we want to make people healthier and improve local services.
The difference, of course, is that poor integration in reshuffles mean ministers looking a bit stupid.
But in the wider world, it is a lot more important.
Disjointed care can and does impact on people’s lives in a big way. Whether it’s:
• The girl with cerebral palsy who has to start using completely different services when she turns 16,
• The man with bipolar disorder who sees a different community psychiatrist each appointment,
• Or the elderly lady who dies in a strange hospital because there’s disagreement over who should provide the services to allow her to die in her own home.
At the moment, those sort of situations are all too common.
To put a stop to them, all parts of the system have to work together.
That’s when things really get better. Not just with health and social care, but with other factors that affect health, like housing, work and education.
One of the reasons I was so eager to be a minister is so I can push that hard.
The consensus behind integrated care is pretty universal. In government, in think tanks, in patient groups everyone sees it as A Good Thing.
But that’s not enough. We need to transfer it from the academic papers and into the health & wellbeing boards, hospitals and community centres.
It takes a lot of political oomph to do that.
I want to provide that oomph.
From my first day in my new office, I was asking to talk to the Department of Health’s experts on integration. Reading the latest research.
And the first thing on my agenda is to arrange a roundtable with the Kings Fund and a wide spread of other groups, to work out a way of translating consensus into results.
One thing we can be sure of is that there is funding to really get things going.
As announced in the Care and Support White Paper Caring for our future, over the two years from 2013/14, an extra £300 million will go from the NHS to local authorities to get health and social care services working better together. That’s on top of the £2.7 billion transfer to local authorities that was announced in the 2010 Spending Review.
And there will be an extra £200 million over the next five years spend on better housing options for older and disabled people.
On top of that, there is more money for priority services, like January’s one-off £150m to reduce delayed transfers of care.
That sort of money opens doors. But because of the financial situation that we all know about, that money - and people’s existing budgets - needs to produce results.
Everyone needs to do their bit to get the most from their money. Delivering better services and better outcomes, in ways relevant to individual areas.
That’s why I was so pleased to see that the Care and Support White Paper clearly sets out what we are going to do to further integrate services.
One of the big issues is that ‘integrated care’ itself is a problematic phrase. Understandably, when you’re talking about such a broad concept, there’s a lot of disagreement over what it means.
So one of our early tasks will be to try to at least agree a working definition - one that allows everyone to be clear about what we’re working towards.
Then we want to build on some of the projects already underway that touch on issues of integration, like the four community budget pilots that are cutting red tape and reducing duplication in specific areas.
We will take the lessons from those pilots and share them across the country, so everyone can benefit.
To gauge our progress, we will also take heed of the Future Forum’s calls to measure people’s experience of how their care is being integrated. We want to explore how best to do that via the outcomes frameworks, so integration is given just as much importance as any other big NHS issue.
We will use different payment systems to put money in the hands of people who can improve integration. The Year of Care tariffs, for example, which take a long-term view of people with long-term conditions. And we want to see similarly innovative payment systems across the health, care and housing sectors.
And of course, throughout all this, in the spirit of integration, I want to make it quite clear that expert organisations like the Kings Fund, the Nuffield Trust are central to everything we’re doing.
We have already accepted the Future Forum’s recommendation following the joint Kings Fund and Nuffield Trust report that far more work is needed to integrate all public services.
The White Paper said we would work with the NHS Commissioning Board, Monitor, and the Local Government Association to support evidence-based integration across the country.
And we have set up a new joint unit in DH across health and social care to look specifically at how the recommendations of your report can be taken forward.
But your input won’t stop there. I want to hear about your suggestions, your criticisms and your research. So every change made specifically to increase the integration of care is itself the product of co-operation and shared endeavour.
That is also true for publicly funded groups like the NHS Commissioning Board and Monitor. We will work closely with them to make sure we are reading off the same hymn sheet.
There isn’t enough time to go into all of it, but I’d also like to quickly mention some other measures in the Care and Support White Paper that will help integrate services:
• Personal health and care budgets, so people can control their own care.
• And more attention than ever paid to important ‘hand-off’ moments where someone’s care goes through a big transition - like when a terminal illness means someone starts using end-of-life services.
Those are all steps in the right direction.
But as I said earlier, for integration to work it can’t just be seen as a health issue, or a social care issue. Everyone has to buy into it and do their bit to make people healthier.
Health and wellbeing boards
Health and wellbeing boards will bring previously disparate people together to do just that.
The NHS, local government and communities themselves. To understand what local needs are and work out how to meet them.
I’m really delighted that you have all been so open with each other about your experiences of setting up health and wellbeing boards.
Through events like this, and through the National Learning Network for health and wellbeing boards, you are coming together with your colleagues around the country to share what you’ve learnt.
But like all ambitious changes, it won’t be easy. A lot of ways of working will have to change. People will have to move out of their comfort zones and look at what is better for local people, not what is better for their own organisations.
Because this is about real change, not just meetings and working groups. If health and wellbeing boards are no more than committees then we will have failed.
The real work of health and wellbeing boards will be outside the boardrooms, with communities, providers, local organisations, voluntary and community groups, GP practices.
Leaders in all those groups will need to get better at working together. The NHS Leadership Academy, ADASS, LGA and the National Skills Academy will all help by developing skills and supporting individual leaders.
And the new Social Care Leadership Qualities Framework and Leadership Forum will help as well.
But in the end, it will come down to individual leaders themselves, and how willing they are to embrace a different way of working.
I’ve only been a minister for a week. But I’ve already got a clear picture of how grateful everyone in the Department of Health is to groups like the Kings Fund for the support they have given to projects like the National Learning Network for health and wellbeing boards.
I hope we can continue to work together to build on that.
So please, tell me about your experiences of how care can be brought together. What works and what doesn’t.
My roundtable will be one place we can discuss how to progress, but to be sure, this won’t be a here today, gone tomorrow issue.
I give you my word that I will push integration as hard as I can.