Comment

Collaboration and innovation will break down barriers to health and social care integration

Professor Lord Patel of Bradford OBE, former chair of the Mental Health Act Commission, makes the case for a radical new report that offers practical solutions to breaking integration barriers.

How many times have we heard that if only we had full integration of health and social care, we would be able to improve the lives of those who need services and reduce costs? If it’s that simple, what’s stopping us from making it happen? 

Integration of health and social care has been a key policy aspiration for a long time, but most of the key barriers to achieving this remain resolutely in place: 

• Estates and facilities – the infrastructure and locations for service delivery are costly and no longer fit for purpose
• Workforce – professional barriers impede joint working and prevent whole-system practitioner and leadership development
• Financial barriers – in many places health and social care budgets are still separate
• System barriers – health and social care systems are currently governed, structured, organised and inspected separately 

A new report by the Rt. Hon Hazel Blears, the former communities secretary, Dr Jon Bashford, founding partner and designated member of Community Innovations Enterprise LLP, and myself, ‘Breaking Barriers: Building a sustainable future for health and social care’, provides a practical model for integration and innovation to overcome these barriers and speed up the pace of change. 

I firmly believe that this is not something that we will achieve by fiddling at the edges or making small-scale changes to the way we commission and deliver services. The crisis we face is imminent, it is critical and we have to act now to ensure that we can go forward into the future with services that are secure and will last. 

Local Health and Wellbeing Boards, and planning for sustainability and transformation plans (STPs), show that there is now a strong consensus for integration of health and social care on the basis of a place-based system. 

However, as has been reported in NHE, the collaboration that is needed to drive integration of health and social care has been severely, if not fatally, lacking. 

The Breaking Barriers report shows how this lack of collaboration affects estates and facilities management and, in particular, how this is holding back the government’s strategy for One Public Estate.

Sharing NHS and council estates 

Combining and sharing NHS and local government estates represents one of the most significant areas of cost savings, long-term revenue generation and innovations in how new care models are delivered. Local authorities in England hold £225bn worth of assets, including £60bn in property not used for school and housing. The NHS occupies a total floor space of 25 million m² with estates running costs, the third largest expenditure for the NHS after staffing and drugs. 

The Breaking Barriers model shows that collaboration between local government and the NHS on estates and property management can realise these benefits, but local authority and NHS leaders need to pool their organisational sovereignty to achieve this. 

Workforce planning 

Equally important are the changes we need to make in workforce planning. The changing needs and demands for health and social care require new roles, skillsets, competencies and learning pathways which break down current professional divisions so that we have a workforce that can operate across sectors for integrated health and social care outcomes. 

The requirement to move healthcare provision from acute settings to the community, with a radical step change in prevention and early identification, needs to be urgently addressed. We can do this by taking advantage of the apprenticeship levy and promoting competency-based learning models (used extensively in the US and currently being developed by the University of East London). 

At executive level, we need inclusive leadership that can task the workforce across sectors including the social sector, breaking through organisational and professional boundaries and working for diverse communities and interests. 

The case for a new government department 

Rationalisation of estates and workforce development will not be enough on their own to address the crisis facing health and social care. We need to also drive change through national policy and the legislative framework that currently divides health and social care budgets across the Department of Health and the Department for Communities and Local Government. 

We need, at Cabinet level, to have new incentives to encourage effective collaboration between ministers. We would go further, advocating for a new Department for Health and Wellbeing which would combine the entire health and social care budget. This is essential to support change at the local level, with unified responsibility for health and social care budgets and clear accountability to the people who need and use these services. 

A national government lead alongside NHS England and the Local Government Association is required to remove the organisational and financial silos and to enable local leaders to lift their sights and take a holistic, people- and place-based approach. 

At the report launch, Hazel Blears said: “We are now seeing this happening at local level in devolution plans for English cities and towns. The combined authority in Greater Manchester, one of the most advanced areas taking on integration of health and social care, is combining a £6bn health and social care budget. 

“Underpinning the Greater Manchester model has been clear, concrete and consistent collaboration between local authorities, CCGs and NHS providers. The ability of the elected mayor to pool resources and to create integrated local governance will drive the move to a prevention-based model far more quickly in the future.” 

Though only a few areas have negotiated formal devolution deals, further devolution, particularly of health and social care budgets, is inevitable. As these new models develop, integration of financial systems at national level will provide much needed support. But we also need to help local areas take full advantage of system-wide change and integration.  

New contract and business models 

To move from collaboration to a fully integrated system that promotes and uses innovation for effective change requires new disruptive business models. We also need to encourage disruptive innovation in service delivery, which leverages digital technology as part of the solution and uses new approaches to social investment to deliver better services that improve lives and are closer to service users. 

To ensure this happens, we also need a new approach to contracting that is based on alliance contracts. These enable a range of partners from across the public, social and private sectors to work collaboratively and to share responsibility for delivery of agreed outcomes. These contracts are not currently fully compatible with the NHS Standard Contract but they need to be, so that local area service transformation can be realised on a fully integrated basis. 

In addition, the current regime for national inspection bodies needs to be aligned at local levels with flexibilities built in to the system of quality and standards that reflect local priorities. 

The Breaking Barriers report is a bold and radical document that calls for significant change to address the critical barriers that are impeding moves towards an integrated health and social care system. We are clear that we need to accept the problem and we need to take action now. As long as we accept that there is a crisis and we have the political and moral courage to do something about it, we can build a sustainable future for health and social care that will save money and improve lives.