With their focus on the needs and wants of the individual, the new integration accelerator sites have started in the right place, says Ewan King, director of business development and delivery at the Social Care Institute for Excellence (SCIE).
What is the essence of good integrated health and social care? We asked many people who use services this question when we were developing our integration logic model. The majority said they valued having choice and control over their care and support.
A significant proportion also expressed the desire to only have to tell their story once, with the expectation that practitioners would work together to share information and plans.
We know this is what people want. We also know that past reforms have often failed to deliver it.
Too much energy has been expended on changing structures, rather than focusing on how we integrate care around the person. Moreover, reforms have tended to fixate on how we integrate the NHS and social care, too often ignoring the potential of communities - housing, the voluntary sector and people themselves - to be part of the solution.
The new integration accelerator pilots, announced in March, offer an opportunity to learn from - and avoid - these past mistakes.
It starts with the person.
The aim of the pilot is to test the introduction of joined-up approaches to assessment and care planning for people who receive needs assessments for adult social care.
By building on good practice in personalised care and support planning, individuals are able to have more productive and bespoke conversations with practitioners, focusing on what matters to them.
For those that it would help, they will also provide people with an integrated personal budget. In a real sense, then, the starting point for this initiative is the person and what they want to see change.
In the three areas piloting this approach - Nottinghamshire, Lincolnshire and Gloucestershire - practitioners talk about adopting a strengths-based or asset-based approach. By connecting people to networks within their local communities they are able to maintain their independence for longer, and receive support in the self-management of their own health and care.
In Lincolnshire I was told this: ‘It’s not about creating an ever-more efficient way of helping people in and out of hospital, although this is important, but more about preventing people going to hospital unnecessarily in the first place.’
Part of the problem with previous initiatives is that they have failed to build a joined-up picture of the care and support needs of individuals, meaning that people have already reached crisis point when support arrives.
In the pilot sites, concerted efforts will be made to join up social care with primary and secondary health care at an earlier stage, around the individual and enable them to access support for self-management of health conditions.
Wellbeing and reducing social isolation
SCIE is providing sites with evaluation advice, and one of the most interesting developments so far is determining what practitioners regard as the most critical success measures.
Of course the sites want to see positive shifts in unplanned admissions and delayed transfers of care, but they also want to see increased wellbeing and reduced social isolation. This strikes me as encouraging; reflecting a belief that this initiative needs to deliver many more holistic benefits to people.
Integrating health is notoriously difficult. The three local areas I mention, like the rest of the country, face mounting demands for care and also challenging financial circumstances. But with their focus firmly on how individuals can achieve more choice and control in their care, they have at least started in the right place.
Comment by Stella posted on
Sounds good, but how do we continue to provide necessary support to people who are deemed to have mental capacity but do not understand what this really entails? There's a huge gap coming of social care support being given to the elderly and people with complex needs but missing the needs of those above (who could be any of us at any time).
I work in day social care and we're in crisis. Community care is a great ideal but can't meet the cost of the resources needed & the increasing business model of privatised care provision will not be able to make their profits if providing the same. And crucially Choice and Control is good for people with mental capacity but for those that don't it's opening the door to more financial abuse than we already see.
Comment by Pauline posted on
I work in H & S care and have an adult son with LD and PD and live in one of the areas participating in the pilot and they are TOTALLY budget driven and not person centered at all. Actually most people have a very good idea of what choice and control they want despite not possibly having full capacity.
My experience is that despite advocacy where he clearly said what he wants this has largely been ignored in preference of cheaper "options" that actually are a million miles away from what he has clearly stated.
For this to truly work for all, full capacity or partial capacity, it's going to take decent funding and that just isn't there. So I fear, that like many other " good ideas" of the past this is just another that is great in theory
but I agree with Stella it opens the door to people being short changed in every aspect
Comment by Miss. Cairns posted on
This sounds positive but fundamentally, HOW DO PEOPLE WHO NEED THIS HELP AND SUPPORT, access it ? I have found from people who need these services that they STRUGGLE to even know how to go about getting the help they need. It is often said prevention is better than cure so surely focusing on people's needs at an early stage would be far more economical before their problems esca;ate causing more financial cost to the services available.