The publication of the Government’s White Paper on integration had me thinking about a podcast that we produced a few days before the first COVID lockdown in March 2020. It was part of an NHS Confederation / Social Care Institute for Excellence (SCIE) report that described the essential role of place-based approaches in taking forward the NHS reform agenda. Based on interviews with senior leaders, it highlighted how local systems can make progress in designing and delivering place-based, integrated care; and what system leaders can do to make this happen.
Leaders in Bradford and elsewhere were interviewed about their experiences with health and social care integration, and the podcast captured their insights about place-based partnerships and reflections about joined-up working. They were clearly on a journey towards integration, soon disrupted by the pandemic.
Nearly two years later, integration remains a policy ambition but one with renewed Government commitment. The Health and Social Care Integration: Joining Up Care for People, Places and Populations White Paper published last week confirmed the centrality of the local place in transforming care. By focusing on the enablers of integration, the White Paper offers the scope for accelerating efforts already underway. What is new? What will be different on the ground?
The White Paper emphasises accountability for the delivery of integration and the achievement of shared outcomes. The Bradford experience illustrates how strong local partnerships are key to this accountability. To be successful locally, flexibility is essential; the sort of flexibility that Bradford’s social prescribers described in the podcast. Local flexibility enables partners to join up budgets and build on what the community – and citizens in that community – consider their assets. Fortunately, the White Paper expressly permits flexibility in local place arrangements; and this should be welcomed.
The White Paper also emphasises shared care records as a critical facilitator of integration. Experience illustrates how shared records support the joined-up care people expect, but better data does not on its own lead to better outcomes or experiences. Relying on better data as the vehicle for delivering health and social care integration would be short-sighted. We also need to see a culture change in how care is organised, financed and delivered. This cannot be directed entirely by central government.
Culture change also underpins the White Paper’s promise of empowering citizens as an enabler of integration. Involving citizens and communities is crucial for determining how best to meet the needs of local people and expand their care choices. We call this co-production, where people who draw on services have a direct say on how those services are run. Significant culture change from all system leaders will be needed to realise the benefits of co-production.
Rob Webster, who was Integrated Care System Lead at West Yorkshire and Harrogate at the time, and is CEO-Designate of West Yorkshire Health and Care Partnership Integrated Care System, told us that their key ambition is that the overall plan for each place feels like it is the ‘People’s Plan for that place. To enable this, they made sure that within their governance structure they had the public, Third Sector, NHS and council involved at all levels.
We welcome several aspects of the White Paper, including the continuity it offers for integration reforms already underway. Integration is the right way forward, but realising the ambition requires long-term commitment and investment, especially in the workforce. Integration will not resolve the urgent issues of stabilising the social care system or tackling the backlog of NHS demand.
It’s hard to say what will be different because of the new integration White Paper. The post-pandemic pressures facing our health and care systems differ in magnitude from when the report and podcast were published two years ago. Ultimately, the success of the White Paper’s proposals will be judged by whether they make a tangible difference to people’s experiences of care. We have a long way to go. And that is the key lesson: Integration is a journey, not a quick fix.
Deborah Rozansky is head of policy, research and information at the Social Care Institute for Excellence (SCIE)
@SCIE_socialcare