'What we know is that our current models for delivering long-term care aren’t sustainable. We can’t keep being paternalistic and wanting to fix everybody and expecting everybody to just comply with our medical models of care for those conditions.'

This might sound like it’s something from NHS England’s Five Year Forward View (albeit less formal), but someone from Somerset CCG said it just a couple of months ago. Along with other local health economy stakeholders in Somerset, they felt that their local system could no longer continue in the same way.

A bit of context first

Long-term conditions aren’t going to go away, even if you have the best prevention interventions in place. In fact, the number of people with multiple long-term conditions is set to increase from 1.9m in 2008 to 2.9m by 2018.

Out of the need to deliver care differently for people with long-term conditions, health economies in Somerset and Leeds are implementing the ‘House of Care’. The House of Care is a coordinated, proactive and enabling approach to improving the health and care for people with long-term conditions. It’s based on the model developed and piloted by the Year of Care partnerships in 2007. The rationale is that if you enable people to be involved in care and support planning and coordinate services to meet their health and life needs, then this may improve their care experience, reduce service inefficiencies, and not only reduce further health deterioration but potentially - and importantly - enhance their health.

Gathering frontline perceptions

I’ve been speaking with various people from clinical commissioning groups and public health in Somerset and Leeds to find out how they’re getting on with the House of Care.

The short story is that both local health economies are doing well at this early stage and they’re implementing the approach in many GP practices across both regions. The journey so far has also not been entirely straightforward and raised a number of questions around how best to implement change in a local health economy, namely: how do you embed a new model into a pre-existing system, to what extent can and should the model be adapted to the local context, and what is the best approach to achieving spread?

Time (and hopefully further rigorous evaluations) will tell how successful they have been. You can read the detailed version of this story in my report here. 

Some observations

There are a few things that really stood out to me from speaking with people from Leeds and Somerset:

This was not something they were told to do. Not by the Department of Health, NHS England, Department for Communities and Local Government, or any other national body for that matter. What they are doing aligns well with the vision of the Five Year Forward View, but their efforts were born from their own recognition of the need to change. They are demonstrating that locally-driven change is not just possible but also energising.
They are making changes based on what they believe in – where the whole local health economy works together, involving health, social care and multiple organisations and other sectors, to coordinate their efforts and vision to meet people’s health needs.
They are quietly, without national promotion, working to transform their local health economies. This isn’t a national programme that’s getting lots of coverage and a tidal wave of national support. These are people working under immense resource pressures to shift their old ways of thinking and working.
They strike me as being incredibly brave. They could be just working to keep the ship afloat (which is highly commendable by itself) but they are actually taking the risk to make the necessary changes, even in such a pressured current climate. This sets an inspiring example to other health economies. This isn’t about all health economies across the UK adopting the House of Care as it’s not the only model for working collaboratively to meet people’s health needs. Rather, Leeds and Somerset are inspiring examples of how you can work differently if you are brave and committed.

For local health economies to work differently, there must also be sufficient resources and the supportive national policy context to enable this to happen. National bodies have further work to do to support local change, as found in our Constructive Comfort publication, and we made a strong case for a transformation fund to provide sufficient resources for such change.

While we await the resources and support that local health economies need, we don’t have to wait for the Vanguards to spread nationally. I heard numerous other people speak about the issue at hand, and it’s unlikely Leeds and Somerset are the exception here. Other local health economies can take inspiration from the quiet bravery of Leeds and Somerset to take the first steps on their journey of transformation.

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