The latest national health and care policy contained within the NHS Long Term Plan and other Government policy guidance comprises a plethora of embryonic spatial footprint structures and concepts that rely on the key role of ‘place’ in transforming health and care.
These include PCNs (Primary Care Networks), ICPs (Integrated Care Systems), STPs (Sustainability and Transformation Partnerships), BCF (Better Care Fund) and that is just some of the health and care bit.Could we be in danger of drowning in a sea of confusing and disparate piecemeal ‘place’ initiatives and missing the point of place and people (not just as patients) at the beating heart of our local neighbourhoods and our communities?
At the same time we have the eagerly anticipated devolution White Paper and the possible reorganisation of local government. Place-based strategies are being developed separately by the Ministry of Housing, Communities and Local Government (MHCLG), NHS England and other Government departments. Maybe what we need is an integrated plan for place; starting with the person, their family, their neighbourhood, their town, their sub-region?
All of these centrally but separately designed initiatives are created with the aim of encouraging local innovation. However, what we can end up with is a set of shiny new partnerships, sometimes with new money attached, overlaying the same old responsibilities and loyalties.
Sometimes we need to simply make the time to take a step back and get back to basics. It’s the ‘so what?’ question. What actual difference will this reconfigured service make for our local communities in their day-to-day lives? Have we designed it with them? Does it address the issues that people and families face and the reality of how they live their lives?
There are many case studies of how small grassroots neighbourhood community and voluntary groups, especially mutual aid groups during the COVID-19 pandemic, worked day and night to improve the health and wellbeing of people struggling with shielding, mental health issues, social isolation, loneliness, bereavement, loss of employment and social status, domestic violence and family breakdown.
And yet we tend to focus on reshaping and reorganising the deckchairs of our formal paid healthcare and other professionals and the legal structures and contractual arrangements of health and care while it is the social fabric of communities that needs our investment and support.
We also know in our hearts that place will be pivotal in the implementation of the new NHS People Plan.
How we remodel and make our health and care workforce more flexible will depend on what extent we work with local councils, the police, schools and other local public services to develop a place-based workforce and system rather than an organisational values-based development plan.
We have all experienced the layers of professionals from different organisations and disciplines often descending often in an incoherent fashion on households who need our seamless support.
We know from all the international evidence and from Hilary Cottam’s Radical Help that this way of working is the only way we will transform public services and rebuild communities for the better. We also now know the essential role of adopting a place focus to public health and epidemiology from all the evidence we have seen during the COVID-19 pandemic.
Social care could be moving into the NHS but local government knows the best examples of high quality social care for older people and for adults of working age are rooted in person-centred, place-based partnerships with local third sector partners and charities. Do we need to nationalise social care or do we need to localise the NHS?
Until we stop obsessing about the process of place – delivering separate Government strategies in isolation from each other, organisational sovereignty, commissioners v providers and the strange dance of the annual contracting cycle –and partnership governance can begin to genuinely and meaningfully reconnect with the public and the places they live in on our public service reform journey we won’t change anything.
Professor Donna Hall CBE, is chair of the New Local Government Network (NLGN) and chair of Bolton NHS Foundation Trust