It's not just about changing structures says Ewan King, Director of Business Development and Delivery at the Social Care Institute for Excellence.
The plan to develop a single budget worth £6 billion for Greater Manchester, involving 10 local authorities and 12 clinical commissioning groups (CCGs), has rightly created a great deal of excitement.
But, as the architects of this plan no doubt acknowledge, structural change, even at this scale, is insufficient on its own to improve people’s lives. What’s also required is good joint working between different professional groups, and between people providing care and support; plus citizens. And this involves much deeper cultural and behavioural change.
Developing effective joint working is the subject of a new how to guide that we at SCIE have contributed to. It talks about the need for us to shift our focus from the traditional ‘supply’ side of health and care service provision, to a ‘demand’ side, where people and citizens themselves can help us achieve better outcomes. This is all part of the National Better Care Fund Support Programme.
What does this mean in practice? Firstly, it means we need to find concrete ways to involve citizens as equal partners in defining, commissioning and delivering better integrated care. Simon Stevens, Chief Executive of NHS England, recently talked about the renewable energy of carers, volunteers and people themselves. This means there is a need to develop, as part of the vision for local integrated care, a clear strategy for building community capacity. This should include investing in schemes such as time-banking, befriending, community navigation, peer support and volunteering.
The ‘Working Together for Change’ approach is one model that can be developed to ensure that change locally is co-produced with people and families. In Lancashire, for instance, this model is now embedded in the commissioning cycle, and has recently been used to review how well direct payments are working for people locally.
Secondly, we need to find better ways to encourage joint working between frontline staff in our quest for better integrated care. Getting this right is crucial, as frontline staff – along with many managers – operate at the join between the citizen and services, and therefore can directly champion their involvement in helping to integrate services.
Of course, doing this well will be challenging. Frontline workers may feel that they are taking the brunt of change hitting the sector and are suffering from ‘change fatigue’. So as a first step, it’s important to acknowledge the significance of the change and to ensure that frontline workers are able to articulate their views; and can help design the new joint working arrangements. It’s better if the intended change is communicated in person, alongside a clear plan for how staff can co-design the new joint working processes; that is, involving them in this plan from the outset.
Thirdly, we need to ensure that managers are driving change. It’s really important to have a clear plan as to how they can target, address and engage operational management in joint working. Even if senior leadership is clearly committed to driving forward working in a new way, success can be impeded by a lack of understanding or buy-in at this level. Managers benefit from having a clear mandate for change, and need to be supported to communicate this to their staff. Managers will need to spend more time gaining a real understanding of where the people in their joint team have come from, and what they have been accustomed to in their previous organisations.
What Greater Manchester is planning is at least having a short-term galvanising effect on health and social care. But ensuring good joint working is in place, is at least as important as agreeing to pool budgets and work differently at the senior level. As our Chief Executive Tony Hunter said on Radio Manchester on the day of the announcement: “From the point of view of the average person, they don't care where that money's coming from. They just want a clear, simple, easy-to-access system that helps him or her to live the best life possible.” Better joint working will help us deliver the services that people need and want.