A friend recently told me she’d had eleven assessments in the past year, all relating to her health and care needs. When attempting to more closely align health and social care, the last thing we should do is add an ‘integrated assessment’ to that list. Let’s reduce the duplication and bureaucracy that characterises the current system, not make it worse.
Any push toward integration should begin with the experience of the person who needs support and the promotion of their wellbeing – an approach enshrined in the Care Act 2014.
At SCIE, we’re working with local authorities up and down the country to implement the Act, alongside the implementation of their Better Care Fund plans. Once localities have grappled with the huge challenges of making this happen, eyes will likely begin focusing on a wider programme of ‘full integration’. A consensus appears to be emerging which puts health and wellbeing boards at the centre of integrated health and care commissioning.
If this is mandated, much thought will need to go into transforming boards into bodies which strategically drive, plan and commission services for local wellbeing. Currently, boards are a statutory meeting – they have no resources and are reliant on their component organisations. This will need to change: the danger is that we rush towards establishing yet another organisation based on the membership of these boards, with a set of processes to manage the interests of the various organisations involved. A further risk is that we let the challenges of coordinating IT, data protection, payment systems and procurement get in the way of design from the ground up.
We should begin from the principles of co-production, sharing control with people who use our services. Let’s measure progress by how close we come to an integrated experience, something akin to what is described in National Voices’ excellent Principles for Integrated Care. We should focus on ensuring people only have to tell their story once, that they have a main point to go to for help when they need it, that they co-produce their support plan (which emphasises flexibility and, if appropriate, the use of personal wellbeing budgets), that they are given clear and consistent information and don’t end up managing communication between the parts of the system.
Let’s locally figure out how to make this a reality, then build organisations and systems: form following function. Integrated care is what is needed, regardless of the vehicle. This shift will take time and requires leaders to share their power with staff and, vitally, with people who need care and those who support them. This means putting short-term interests aside and taking real risks to put people first.
Patrick is Practice Development Manager (Policy) at the Social Care Institute for Excellence, www.twitter.com/PatrickHSCIE
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