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The Policy Landscape for for Integrated Care in the UK

Integration has been a longstanding policy objective of all governments since the 1960s, but last year’s Spending Review stipulated that all areas should have a plan for the full integration of health and social care by 2017 and that this plan should be implemented by 2020

In the past year, two significant new policy developments have emerged:

  • The first is devolution, with the Cities and Local Government Devolution Act receiving Royal Assent on 28 January  2016 - Greater Manchester’s devolved health service came into force on the 1st of April when the region’s entire £6.2bn health and social care budget was handed over by the government to a new body of local health chiefs and council leaders.
  • A second development is the emergence of a different approach by NHS England to planning based around wider health systems rather than separate organisations. The footprints and leadership of the five-year sustainability and transformation plans (STP) have now been confirmed. By June each designated STP area must produce an ‘ambitious local blueprint’ with a triple aim of better health, transformed service delivery and sustainable finances. The blueprint must cover better integration with local authority services, including prevention and social care, and reflect agreed health and wellbeing strategies.

 

A shared theme of all these developments is a focus on integration based on place rather than organisations - the following are a range of reports and papers that have been produced on this topic:

Get Well Soon

This report demonstrates that the health service in its current form is not sustainable, and sets out a new plan for shifting the system to focus on preventing illness, shorten stays in hospitals and help people live independently for longer.

As well as a new 15 year forward view for the NHS, the report recommends a route map towards place-based health by 2030 including:

  • A  focus on making the best use of existing funding, but any new resources for health announced by government should be designated to support a transition to place-based health
  • Metro mayors and council leaders to be in charge of pooled budgets and other financial models that ensures places rather than institutions are held to account for health outcomes
  • A renewed focus on people’s wellbeing to drive a reduction in health inequalities.

The report’s findings show that it is only by full scale transformation from an institutional service to a place-based approach to person-centred health and care can secure the future of our health system and ensure our population are happier and healthier.

This would act as a blueprint to create an agreed vision of place-based health across all institutions currently working in a separate and fragmented way. These organisations coming together to deliver things differently will be essential to making sure the NHS and all its broad spectrum of partners - from local government, housing providers, schools, community pharmacies and charities - achieve a shared vision for health and social care.

 

Devolution: What it means for health and social care in England

Devolution of powers and funds from central to local government has emerged as one of this government’s flagship policies. This briefing describes the origins of the devolution agenda and charts its progress in relation to health and social care.

Placed-based systems of care - A way forward for the NHS in England

This paper proposes a new approach to tackling the growing financial and service pressures the NHS in England is facing at a time of rising demand. It argues that NHS organisations need to move away from a ‘fortress mentality’ whereby they act to secure their own individual interests and future, and instead establish place-based ‘systems of care’ in which they collaborate with other NHS organisations and services to address the challenges and improve the health of the populations they serve.

 

Place-based Health: a position paper

There is widespread recognition of the wider determinants of health, where only 20 per cent of health outcomes result from clinical treatment and the remaining 80 per cent determined by wider factors such as lifestyle choices, the physical environment and family and social networks.

This position paper sets out some of the challenges in achieving a fundamental system shift in practice towards a place-based a system that opens out the definition of health from clinical care to one that encompasses wider determinants, citing evidence from health and local government professionals. It starts to look at how the services and resources that already exist can be better aligned and utilised to contribute to better and more equal outcomes for people.

 

NHS shared planning guidance 16/17 – 20/21

This guidance outlines a new approach to help ensure that health and care services are planned by place rather than around individual organisations. Every health and care system needs to produce a sustainability and transformation plan (STP), showing how local services will work together to improve the quality of care, their population’s health and wellbeing and NHS finances.