The LGA sets out five key principles for service reconfiguration

policy digest

20 / 10 / 2015

Shared principles for redesigning the local health and care landscape 
Local Government Association, October 2015


This document from the Local Government Association (LGA) describes five key principles for the whole system on developing proposals for major service change and reconfiguration. The principles particularly emphasise the need to co-create and co-design new services in partnership with service users and the community.

There is a widespread consensus on the need to redesign the health and care landscape to meet growing demographic and financial challenges. A number of key policy documents have highlighted the pressing need to shift the focus from hospital treatment to community based care and support. 

The LGA has called for all local system leaders to promote shared principles or key tests for health and social care redesign to support local consultation. The shared principles outlined in this document are intended to provide a consistent and rational framework within which to test that proposals are person-centred, locally appropriate, evidence based and focused on whole-system effectiveness. 

1. Do the proposals promote a person centred approach? 
Care should be planned with individuals and focused around people’s needs. Furthermore, it should be ensured that systems are in place for individuals to receive help at an early stage to avoid unplanned admissions. 

2. To what extent are they rooted in local accountability?
The public should understand and support the vision for service redesign and case for change. There also should be community and patient engagement and opportunities for patients, service users and their carers to design and shape the development of commissioning plans and services. 

3. Are the proposals evidence based?
Proposals should draw on evidence of the joint strategic needs assessment regarding the key health and wellbeing challenges facing the local system now and in the future. They should also build on and adapt existing national evidence, regulations and good practice from the UK and elsewhere. Finally, evidence should represent from the proposals good value for money. 

4. Do the proposals promote a place-based community budgeting approach?
In relation to the community, proposals should be based on a shared system-wide understanding of key health and wellbeing challenges. Furthermore, they should effectively reduce duplication, address gaps in services and access to services. A shared understanding between partners of the reform agenda and promotion of shared local visions should also be included in proposals.

5. Will they make a difference?
Evaluation will be key for the proposals. Services will need to understand if their proposals have made a difference and to develop key timescales and checkpoints for evaluation. There is a need to look at the extent to which the proposals will improve users’ experience of health and social care services. Furthermore, evaluation should identify and mitigate risks across the system and to individual sectors and organisations. 

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