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We are Moving Towards Place-Based Health Care. What Does this Mean for Social Care?

18/05/2016 15:38 | Updated 18 May 2016

The end of June is an important date for the health and social care system. It is when 44 geographical areas, called 'footprints', are expected to submit their Sustainability and Transformation Plans or STPs.

This marks a seismic shift away from planning for care driven largely by individual organisations - be they NHS trusts, local authorities or clinical commissioning groups - towards planning driven by whole systems working together. Yes, there are Health and Wellbeing Boards, which have sought to produce a single health strategy for local areas, but for the first time, these plans are going to be attached to significant amounts of national funding. At least that's the ambition; its early days of course!

The vision for the future described in the planning guidance should be really appealing to those working in social care. As I wrote in a blog for NHS England, the guidance talks about the importance of constructing a shared vision, in conjunction with communities, and being based on sound principles of community engagement.

Local government, and within that, social care, has had a long track record in engaging with communities. Forged through years of work on personalisation and community empowerment, the sector has built up extensive expertise that others can learn from. In developing STPs and other place-based plans, it is vital that planners tap into this knowledge.

NHS England wants a 'radical upgrade in prevention, choice and control, and community engagement' so that communities become more self-reliant and reduce demands on the acute sector. Faced with its own financial challenges, social care has for some time been focused on building up the capabilities - or 'assets' - of communities so that people can live independent lives for longer. If everyone works together, there is much that can be achieved on preventative care.

The focus on place itself should be an attractive notion to those in social care. Local government and social care have been at the forefront of creating place-based approaches, starting with the Total Place initiative and moving onto community budgets. In constructing STPs, it is vital that plans build on these past efforts.

But there is a real danger that local government, and with it commissioners of social care, are left out of the picture. Chris Ham of the King's Fund wrote that some local authorities are already concerned that they will be an 'afterthought'. And a recent report by the New Local Government Network claimed that: 'There is a risk that NHS-led reform imposes a siloed institutional dominance to integrating health and care services.'

This of course must be avoided. In the Hampshire and Isle of Wight area, for instance, careful attention has been given to ensuring that local government, social care and the voluntary sector play a prominent role on the governance structure for the STP and that co-design with communities is built into the development of the local plan. This approach should be welcomed.

Ultimately, a place-based outlook can only be realised by people accepting that there is something bigger than their own organisations. This means not just accepting that other organisations have a legitimate stake in shaping place-based approaches, but also that communities must be given power and influence over any future plans. For this to happen, brave and outward-looking leadership is a must.

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