Put people first

By Stephen Chandler | 03 February 2021

In approaching the topic of collaboration and integration, I find myself in an interesting position. I spent much of the first 21 years of my career working in the NHS as a nurse and then as a senior manager.

More recently, I worked in various integrated roles and most recently, as a director of adult social services (DASS) in Somerset and now Oxfordshire. My roaming roles have given me a clear understanding of the unique differences that define the NHS and local government, our respective strengths and, what we each do best and what we do better together.

Given my current role, as a DASS and as the vice president of the Association of Directors of Adult Social Services (ADASS) I have a practical interest in the role of local authorities in system working and in the perennial debates about collaboration, integration and organisational forms, so I want to share a number of personal observations.

First, I prefer to talk about collaboration rather than integration. The former paints a picture of organisations working alongside each other, with agreed common goals, pooling sovereignty and pulling together. The latter immediately shifts your thinking to organisational form, mergers, takeovers and hierarchies. The former very quickly leads to a conversation about people and outcomes, the latter to a focus on organisations and management structures.

Second, the real strength of local councils is that we are embedded in place. The very nature of our structure and reason for being is determined by our local footprint. We have no jurisdiction beyond that footprint and are responsible for everyone within it.

By contrast, over recent years the NHS has been encouraged to increasingly think about bigger footprints and dispersed geographies – with the catchment areas for our large acute hospital and specialist centres extending regionally way beyond the towns and cities in which they are physically located. Put simply, councils have a responsibility to the whole population of that place, not only those who are physically or medically unwell.

Third, when talking about health and social care there is a tendency to focus on institutions and buildings. We have seen this illustrated time and again during the pandemic, with the media and politicians almost exclusively focused on what is happening in hospitals and then latterly in care homes. This masks the reality that the vast majority of those of us with care and support needs receive that support in our own homes and within our local communities.

Fourth, allied to this, too often the focus is on the relationship between acute hospitals and adult social care, with everything boiled down to the issue of hospital discharge.

This invades thinking about collaboration and integration. It masks both the brilliant array of things adult social care does and the previous point about the importance of home and community-based care and support to so many of us.

ADASS recently published nine statements to help shape adult social care reform which clearly sets the ambition that the future of care and support must be built around care and support provided in our homes and in our communities.

If you support the notion that the future of care and support is about what happens in people’s home, families and communities, then conversations about collaboration and integration should be dominated by the relationship between social care and housing, and the primary social care-NHS interface is with NHS community services, mental health and primary care.

The interface between the acute hospital and adult social care becomes secondary. The key is to work with older people, disabled people, carers and other stakeholders to build a vision of the care and support we all want for ourselves and families in the future. Seen from this standpoint the conversation about collaboration and integration feels very different. I would suggest the future is about people, homes and communities, not organisations, buildings and institutions.

Stephen Chandler is director of adult services at Oxford CC and vice president of the Association of Directors of Adult Social Services


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