Integration and personalisation is the cornerstone of all current NHS and government policies. There’s an awful lot of information out there – run a search online and you will be swamped- one study found 175 definitions of integrated care! The Better Care Fund is the main lever bringing health and social care organisations together to plan, fund and commission integrated services. Personal Health Budgets (PHB’s), with support focused on how people want to live rather than just their health needs, are another important part of the integration agenda. It would be hard to disagree with any of these sensible ideas of joined up services and person centred care – integrated services that value people as individuals fits perfectly with the ethos and model of Shared Lives. Our NHS programme is therefore well placed as part of the integration agenda, sitting within NHS England’s Integrated Personal Commissioning (IPC) service.
But what does integration mean in practice and how will we know if it is actually happening? I started to wonder about this back in February when an Audit Office report concluded that integration has been slower and less successful than envisaged. It found that although the Better Care Fund has increased joint working, this integration has not delivered better outcomes for patients, the NHS or Local Authorities. A further report from the Social Care Institute for Excellence (SCIE) identified problems for integrated working as conflicting polices, different funding systems, different eligibility criteria for health and social care service and separate governance arrangements. SCIE said that the focus of integration on improving systems and processes didn’t necessarily translate into better care; they highlighted a need to identify what good integration actually looks and feels like to people using services.
It seems that putting integration into practice is harder than producing buzzwords and policy documents; and our experience at Shared Lives Plus certainly bears this out. We have found some disconnect between government and NHS policy and what is happening on a local level within Clinical Commissioning Groups and Local Authorities. Many of us at Shared Lives are having conversations with health commissioners and hospital discharge teams, but the referrals coming in are via the usual routes – from social work teams who know and understand the Shared Lives model of old. Personal Health Budget’s sound like the ideal mechanism for funding Shared Lives arrangements, but we have not yet seen this happening in any significant way.
There have been times when I’ve felt like one of the townsfolk going along with the excitement about the Emperor’s magnificent new clothes, when in fact he is naked and nobody dares create upset by pointing this out. There is clearly much work still to be done in raising awareness of Shared Lives, in accessing referrals via integrated pathways and pooled budgets. In some areas of the country Integrated Personal Commissioning (IPC) demonstrator sites do appear to have clear ideas about commissioning Shared Lives through health, but in other areas it is very early days for the integrated systems, and too soon to see the effects in terms of funding Shared Lives arrangements.
On the positive side, we do have successes to share. I’ve been encouraged by seeing first-hand how health and social care integration is being played out in some of our match funded areas. Clinical Commissioning Group’s (CCG’s), Local authorities and Shared Lives schemes are talking to each other and demonstrating a real enthusiasm for doing things differently. New relationships are being formed, awareness and understanding has increased on both sides, and new pathways and processes are starting to take shape. Some of our colleagues have found new ways of working with health and social care commissioners. For example, Bolton Shared Lives scheme are sitting on the joint allocation panels at the CCG, where Shared Lives is the first option for care and support. Bolton are also receiving referrals into Shared Lives via the community mental health teams.
Our team recently visited Northumberland Shared Lives to learn from schemes working in health outside our match funded programme. Northumbria NHS are a NHS England vanguard site trying a new model of care called a ‘Multi speciality Community Provider’ (MCP). Julie Shepherd, the Shared Lives manager told us how having shared offices, shared back-office systems and pooled budgets means that awareness of Shared Lives is high in both health and social care in Northumbria, resulting in seamless commissioning and funding pathways. In this environment Julie says; ‘accessing Shared lives is an ‘open door’ for health and social care professionals’. I found it really refreshing to see Shared Lives Northumberland positioned as the first option on the ‘Accomodation and Care homes’ page of the Northumbria NHS website (above Care homes!).
We all know the pressures on the NHS; perhaps we just need to be more patient. There is change in the offing – the government’s aim is for health and social care integration by 2020 and an ‘integration standard’ is being developed – to show what ‘good’ looks like. NHS England have produced an expansion plan for personal health budgets with targets for CCG’s to meet. NHS England say that PHB’s should now be routinely offered; they expect the number of people with PHB’s to increase rapidly, becoming ‘business as usual’ by 2021.
We know that integration aims to close the divide between people and the professionals who serve them and that it should start and end with people, not structures.