As the ‘Integration Pioneers’ get off the ground, Jules Acton, director of engagement & membership, at charity coalition National Voices, explains why many patient groups are optimistic about real progress. This blog is brought to you by BMJ Quality. For more quality improvement resources go to quality.bmj.com
If you ask people with long-term conditions about the changes they want to see in health and social care, most say: care and treatment that is coordinated around us.
A glance at National Voices’ ‘webs of care’ shows immediately why this call is so strong. The ‘webs’ were drawn up by people who use services, and their families, to demonstrate the tangle of contacts they are trying to navigate. This lack of coordination leads to stress, repetition, waste and, at times, can also threaten people’s safety.
But, of course, coordination in our vast and varied systems of health and social care isn’t straightforward. This is why, at National Voices, we were so pleased about the government announcements on ‘Integration Pioneers’: 14 local areas which could herald a new era in person-centred care.
Before the more initiative-weary of you tune out, I’d urge you to stay with me for a few minutes. There are some important aspects to the Integration Pioneers, which could propel them to success and enable them to bring about real, big and positive change.
For a start, this isn’t only about the 14 chosen Pioneers. There were a huge number of applications for the Pioneers programme – more than 100 – from two thirds of our local areas. That means over 100 different localities, each with multiple organisations, showing a will to work across boundaries: across health and social care; primary and secondary care and all the other points where patients fall through gaps. It indicates an energy for care coordination and a belief in a new way forward. And this energy is coming from the ground up, where it really matters. So, while the government support is important, this drive is less about responding to diktats from on high, but about teams of professionals seeing the Pioneers programme as an opportunity to push out the boat. And, while not all of the areas that applied could become official ‘Pioneers’, that doesn’t mean they can’t also drive forward themselves, share the learning and add to the momentum.
Another cause for optimism is that most of the above have shown a will to work towards a common vision, developed with people who use the services. This is based on the Narrative for Person-Centred Coordinated Care. This is truly significant, because ‘integrated care’ has been interpreted in a great many different ways in the past. As the Health & Social Care Act came into being there were at least 175 different definitions floating around in the ether.
In response to this confusion, NHS England commissioned National Voices to work with people who use services as well as professionals, to develop a vision we could all sign up to. This has happened. It was published in May as part of a common purpose framework to which the Department of Health, NHS England, the Local Government Association, Monitor and all the other national system leading organisations committed. And it aligns strongly ‘Making it Real’ a key personalisation initiative by TLAP. The Narrative redefines ‘integrated care’ as person-centred coordinated care, which, to the service user, means:
“I can plan my care with people who work together to understand me and my carer(s),
allow me control, and bring together services to achieve the outcomes important to me.”
It goes on to offer context in the form of more ‘I statements’ which describe, in detail, what coordinated care looks and feels like to people who use services.
So we have a common vision, we have momentum and we are optimistic. But we aren’t starry eyed. Person centred coordinated care won’t happen overnight, and certainly not across the whole country. The new programmes need time to grow and adapt. Their teams won’t get everything right first time. And this is fine as long as they are able to move on from mistakes and share the learning.
This is where the government comes back in. To nurture coordinated care and ensure the success of the new programmes, our government now needs to learn to sit back, be supportive but resist the urge to dabble, interfere and chuck in new, competing initiatives. As the election looms we hope all political parties will show maturity around this, with their manifestos underpinning solid progress towards person-centred care, rather than revolution and upheaval.
At National Voices we will be championing this need to nurture and not to keep on overhauling. We’ll also be leading work on some extra materials to support coordinated care, such as a toolkit for care and support planning. If you’d like to receive newsletter updates on these then let me know on jules.acton@nationalvoices.org.uk or @JulesActon. And if you are involved in coordinated care programmes, please let us know about your progress so we can help share the learning. We look forward to hearing from you.