14.09.15
Frugal integration
Guest blog by Catherine Pollard, director of integrated care and pricing development at Monitor
Earlier this year, I heard Jonathan’s story and was inspired by it. Jonathan has severe learning disabilities and through the provision of an integrated personal budget (covering health and social care funding) he was able to move back home with his family, improving his wellbeing and independence. This also reduced his annual cost of care by approximately £75,000.
But, when I thought about it, Jonathan’ situation was an echo of the stories I’d heard from visitor’s at this year’s Health + Care show; and observed while travelling round the country for Monitor this summer. It is clear that with little (maybe too little) fanfare, the NHS, despite facing unprecedented financial pressures and almost no spare cash to fund experimentation, is finding ways of providing patients with integrated care that also save money.
We know this is happening in pockets across the country with hugely positive clinical, operational and financial benefits. So, it naturally, begs the question – shouldn’t we all be doing more of it?
Yes! I believe that achieving better person centred and coordinated care for people can help (but not solve!) the financial sustainability challenge we are facing. So if now is the time to undertake ‘frugal integration’ – personalising and coordinating care while also reducing costs – what can local areas practically do?
Local health and care systems are a complex web of interdependencies, including those between hospital and communities, health and social care. I see many local leaders trying to bridge traditional divides to meet the current challenges, even if they place different emphasis on which problem to tackle first. Some places are looking at how they can put a person in charge of their care – perhaps through an integrated personal budget – others are building capacity in the voluntary and community sector, or establishing place based teams. Alongside changes to how care is experienced by people, increasing numbers of areas are also considering how to break down organisational barriers to take out overheads for reinvestment in frontline care and remove vested interests that might hinder all of the above.
I wasn’t only inspired by Jonathan’s story. Another great example I’ve come across where the power of patients is really being utilised is in Halton, where the local rugby club is working with the local community and schools to promote health and wellbeing. The rugby club is working alongside the clinical commissioning group, council and housing trust. Activities have included a world record attempt for the most number of people exercising in a fitness video and raising the profile of prostate cancer.
Meanwhile, Age UK, as part of the Living Well (integrated care pioneer) programme in Cornwall, are harnessing the power of volunteers. They pair people to volunteers who help the person with things like getting them to their support groups to improve older people’s resilience and reduce their feelings of isolation. Preliminary results suggest this programme can help decrease hospital attendances and admissions and also slightly decrease social care spend. Age UK are looking to work with other local areas to replicate similar models across the country.
Engaging people and communities is a theme running throughout the Five Year Forward View. This reflects widespread emphasis on promoting improved, integrated, joined-up services for people and a huge appetite to share examples of what’s been done well and also learning from things that haven’t gone to plan.
At Monitor we support innovation among providers and encourage approaches that are adapted to local circumstances. We advise local organisations on how they can better integrate care across health and social care, while also working with colleagues to join up the national landscape so it’s easier for commissioners and providers to integrate care within it. Monitor also actively support the new care model Vanguards set out in the Five Year Forward View.
Given the financial context which the NHS and local government are currently operating, now is the time to be frugal and act imaginatively to meet people’s needs within the funding envelope. This means making the best use of assets, be it buildings, a patient’s family and social networks, or local community assets like sports teams and volunteers. It means putting the person at the centre and drawing in all resources relevant to meeting their needs, even if they are outside of the organisation in which we work. This applies to the work I do at Monitor, and to national organisations like Monitor.