Integration, collaboration, joined-up working - call it what you will, the concept of closer partnership between health and social care is a familiar rhetoric in the public sector.
The need for better partnership between health and voluntary organisations - and for a stronger, collective stance on the issue within the voluntary sector itself - is clear.
As well as ongoing funding cuts, there are now post-Brexit-related uncertainties relating to workforce, funding, policy and legislation. In addition, CQC are giving integration renewed attention and the need for stronger relationships as is the subject of the recent joint review of partnerships and investment in voluntary organisations in the health and care sector.
In Lambeth, south London, however, the rhetoric about collaboration is becoming a successful reality, thanks to an "alliance contract". Launched in April 2015, this new way of working has radically changed the commissioning and delivery of social care and mental health support.
The single contract is operated by Lambeth council, the clinical commissioning group (CCG), voluntary and community-sector organisations Thames Reach and Certitude, and service provider, the South London and Maudsley NHS foundation trust. Objectives and risks are shared, with provision shifting away from high cost, bed-based settings and towards supporting people at home, at a lower cost.
Bernadette, for example, is one of 200 people with mental health needs supported under the contract. The 58-year-old, who has a personality disorder and recurrent depression, spent 13 years on secure wards in five different hospitals. Having spent most of her life in institutions, Bernadette now lives in her own flat, enjoys walking and cooking and employs a personal assistant. Her support is provided by Lambeth Living Well Collaborative, a partnership of organisations that co-produces support with users of mental health services.
The alliance contract programme is on track to achieve a 20% saving in two years. Personalised recovery packages include social housing, personal budgets, and intensive care and support. Contract incentives are focused on rehabilitation and recovery, so all the partners have an equal stake in boosting - and maintaining - people's health.
The progamme was among the collaborative approaches to health and care support debated at a recent VODG (Voluntary Organisations Disability Group) meeting of chief executive and senior directors. There is a thirst for both knowledge and progress in this area; the vanguard sites under NHS England's five year forward view aim to deliver more integrated services while Greater Manchester and Cornwall are among the first areas to win devolution and the chance to reshape local and regional health, care and support.
So what are the challenges in closer alignment of statutory and voluntary organisations - and what of the potential solutions?
The relationship with health commissioners is among the main hurdles. Many VODG members feel that health commissioners display a somewhat internalised attitude, leading to a "closed shop" approach - certainly when compared to local authority commissioners. Health commissioners, in addition, pay more attention to competition than collaboration and often regard the voluntary sector as something of a fractured group.
To compound the gulf between the two sectors, the impact of austerity means that voluntary organisations are often more focused on survival rather than innovation or on reaching out to their health counterparts.
However, a simple change of language could support greater engagement between the two. Communicating the benefits of voluntary organisations in a health sector-friendly way - acknowledging the pressures for CCGs or accident and emergency, for example - should help.
The Social Value Act offers an opportunity. The act, which requires public authorities to take into account social and environmental value when choosing suppliers might encourage health professionals to better consider community-based organisations and different ways of commissioning.
Another way forward could involve encouraging trustees to take a more proactive role in building bridges with health partners, and raising the profile of social care and the voluntary sector.
We are in unsettling times. Funding cuts, Brexit, public service reform and new models of service delivery are all combining to rapidly change the landscape in which health and care operates. Yet the voluntary sector boasts many innovative projects with well-established and positive outcomes - like the new contract in Lambeth. It is vital to spread word about such approaches and the subsequent impact on communities; they are persuasive examples of what truly collaborative working between health and voluntary partners can achieve.
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