The integration of health and social care, the defining ambition at the heart of recent health and care reforms, was never going to be straightforward: another evaluation last month underlined the enormous challenges faced. News also that that some local areas have struggled to agree Better Care Fund (BCF) plans, adds to the challenges. And we face a worsening financial situation in the NHS and in local government, making it more difficult to invest in new integrated services.
SCIE have been closely involved in supporting efforts to integrate care, including providing direct help to local areas with the BCF. We are aware of the numerous barriers that can stand in the way: Different professional cultures; mismatched funding regimes; incompatible IT platforms. We are also aware that agreements about joint NHS and local authority budgets or pooled budgets have got a whole lot harder to broker as NHS finances have worsened.
Has this led the Government to throw in the towel, or at least moderate its ambitions? Far from it - It has called for fully integrated services by 2020, with areas deemed to be progressing well 'graduating' from the BCF; we await further guidance on how this will work. It's an ambitious plan indeed. And to be fair to the Government, it can still justify its ambitions on the basis that there is still huge sector and public support for more integrated care.
So the destination, if not the exact route to be taken to get there, is fixed. What then can local areas learn from the BCF so far?
Firstly, there is a need for openness and transparency between agencies from the very beginning, when plans for integrated care are being forged. In Sheffield for instance, which has one of the country's largest joint health and social care budgets, decisions are taken by a joint NHS and local authority commissioning executive, underpinned by clear protocols for information sharing and joint decision making.
Secondly, areas that have done well have been good at involving staff and service users in developing solutions together through co-design and what we call at SCIE co-production; when people are involved in designing and delivering the services they receive. This has led to better designed initiatives, like the community matrons in care homes scheme in Darlington which was designed by frontline teams and has reduced emergency admissions.
Thirdly, higher performing areas appear to have grasped the true potential of communities in supporting integration. So in Sandwell local care coordinators, working with volunteers support people in staying independent and healthier for longer. And in Luton, the Better Care Fund is being used to fund a new social prescription service, which refers patients to sources of non-medical community support.
Finally, good areas understand the need for leadership to operate at all levels, not just at the top. So in Haringey and in Leicester huge efforts have been made to equip middle managers and frontline staff with the skills they need to champion integration initiatives.
There is a much overused saying in management that 'if it were easy, everyone would be doing it.' Well this cliché really does seem apt if we are looking at integration; it is indeed proving to be really challenging to deliver. But with good leadership, shared belief and commitment and deep involvement of partners and people in designing better services, greater integration is possible.