Place-based health: Making it happen
Few would deny the need for change, or even what needs to happen to improve our care system. From reaction to prevention, services to systems and institutions, to people and place, the theory is there. But how do we put this into practice?
The answer is not simple. Our needs are complex and so are our systems. We will not reach a consensus overnight but we have to work together to develop a long term plan, forged in partnership, across people, parties and professionals. And, while the answer is not just money, more money is needed to stabilise the system. We won’t be able to work towards something that is sustainable without plugging the ever widening social care funding gap first.
We need to focus on preventionDespite the Care Act 2014 placing a new prevention duty and responsibilities on local authorities, adult social care spend on prevention has reduced since the Act came into force. While local authorities have identified increased prevention and early intervention as the top area for saving, they have also made it clear there are practical difficulties shifting resources away from crisis intervention to prevention given the current economic climate.
Ensuring initiatives, such as the Care Act’s prevention duty, sustainable transformation plans and the further devolution of integrated health and social care budgets are met with additional funding is vital in ensuring they are implemented in a meaningful way. New initiatives need investment. Without this, they continue to be mere ambitions.
We need to focus on people and placeWe must make sure people are at the centre of their own care and move away from a one size fits all approach to treatment and support. When our staff and volunteers first meet our service-users, we ask them what they want us to help them achieve during their time with us. We call this their top three goals. In this way, we look beyond their immediate crisis and condition.
It is not surprising that many of our service users’ top three goals are not directly about their health condition, and the treatment they want to receive or the health services they’d like to access. Rather, they are about managing their day-to-day activities or improving social networks and friendships.
To help them in this way, we need to look at places as a whole, beyond just the NHS to care and support as well as housing, businesses, community spaces, the voluntary sector and so on.
We need to start breaking down silosAs our care systems starts to see people as more than their condition or illness, the need for greater collaboration between medical departments, community services, social care and the voluntary sector will become ever more apparent.
The potential of health and care integration is increasingly drawn on as the solution to an unsustainable health and social care system. The Better Care Fund, health and social care devolution developments in England and sustainability transformation plans all aim to escalate moves towards this. Theoretically, integrated care budgets provide a real opportunity to properly invest in prevention as both local authorities and the NHS would benefit financially from doing so. It would also help eradicate the sometimes false distinction between people’s ‘health’ and ‘care’ needs, which all too often results in people falling through the gaps.
However, more needs to be done to both explore what is meant by integration as well as what is needed to make it work in practice. Is our ultimate aim to simply work better together? Is it to pool budgets? Or is it to go much further and bring the separate systems together as one so that it no longer distinguishes between clinical and social needs? Learning from devolved nations suggests health and social care budgets need to be fully integrated and a legislative framework may need to be put in place to prevent health further overshadowing care.
Going forwardThe situation often feels bleak, but there is an appetite for change. We see this at all levels: from practitioners, to local authority chief executives to Westminster. There is a general consensus as to what needs to happen; now we need to focus on how to make it happen. By coming together and both encouraging innovation and taking time to explore good and bad practice, the British Red Cross are optimistic we can work towards a preventative, joined up system that focuses on people and place.
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