Almost a year on from Dr Claire Fuller’s excellent stocktake report on integrating primary care there is a danger that, like many well-evidenced analyses, we could read the report, fully agree with it, take a report to the integrated care board and do precisely nothing to turn the recommendations into reality.
So where does the real work - the hard graft of genuinely integrating health and care - start? Is it system leaders in the integrated care boardroom? Or in local neighbourhoods with frontline practitioners? Probably both. ICSs are well-resourced to make strategic change happen, but less so with the heavy lifting in local neighbourhoods. And this is where the real magic happens.
The stocktake includes a compelling new vision for integration that centres on three essential offers:
- Streamlining access to care and advice for people who get ill but only use health services infrequently, providing them with much more choice about how they access care and ensuring care is always available in their community when they need it.
- Providing more proactive, personalised care with support from a multidisciplinary team of professionals to people with more complex needs.
- Helping people to stay well for longer as part of a more ambitious and joined up approach to prevention.
Building fully integrated teams in each neighbourhood is critical to making these essential offers a reality. No single organisation or ICB can make this happen without radical cultural change in working arrangements in neighbourhoods.
The ‘team of teams’ approach, evolving from primary care networks, needs to be rooted in a shared ownership of local wellbeing across all local public servants, including primary care in its widest sense, community care, adult and children’s social care, mental health, acute, housing, the police, public and environmental health and, importantly, local grassroots community and voluntary organisations.
This can’t and won’t happen until there is a fundamental cultural shift on two vital fronts, as Dr Fuller observes:
- A different kind of leadership that provides an environment of psychological safety where it is ok to try new things and for teams to innovate to find new ways to support individuals, their families and communities. Top-down hierarchical leadership of neighbourhood co-ordination risks alienating the frontline workforce.
- A shift to a preventative wellbeing model with a clear focus on sharing data, having a joined-up action plan and focusing on inequalities.
The COVID-19 pandemic showed us the vital importance of mutual aid, having networked integrated health and care partners working on the vaccine rollout with communities and providing mutual aid with our incredible grassroots community and voluntary organisations.
Forging a social contract in Wigan
In Wigan in 2011 we created the Wigan Deal with citizens; a new social contract between citizen and state where we worked together across public services to forge a deep and lasting partnership with residents and each other. Part of the deal were seven fully integrated neighbourhood teams, based on PCN, police and social care footprints.
Permission to innovate and courage are at the heart of this kind of radical transformation
We used risk stratification extensively to profile the population for risk factors including unplanned hospital admission, school readiness at the age of four, and falls prevention. By embedding this work in the integrated neighbourhood teams and using shared data and insight, we were able to significantly reduce poor health and increase healthy life expectancy in the most deprived wards within Wigan Borough.
Permission to innovate and courage are at the heart of this kind of radical transformation. That is why I am excited to be chairing a session later this month that brings together local neighbourhood leaders across the country with national and system decision-makers on neighbourhood integration, led by the NHS Confederation’s Primary Care Network.
The session will not only bring to life what integration at neighbourhood level can achieve for local people, but it will help us understand our respective roles in creating the permissive environment to support us on this journey.
We have had enough short-term fix strategies
We all need to commit to this direction of travel. It’s the right direction for our local communities and I am grateful to have the opportunity for those driving integrated neighbourhood working to come together, learn from one another, share ideas, and drive the transformation.
We have had enough short-term fix strategies and pathfinders and NHS restructures. Let’s roll out, at pace and scale, what we know will work and what will last.
Professor Donna Hall CBE is chair of New Local and former CEO of Wigan Council. You can follow Donna on Twitter @ProfDonnaHall