Beyond the Green Paper: Destination Networked Care. Taking the L-plates off

Type ‘integrated care’ into a certain search engine and you are offered exactly 23 million results. In the NHS’s vocabulary, ‘integration’ is a key aim in NHS England’s vanguards/new models of care programme – which features talk of transformative models such as ‘system integrators’. That reflects the emphasis accorded to closer working in the 2014 Five Year Forward View.

A few years on and I was recently invited to join a working group convened by the local government and NHS providers on behalf of the Department of Health. It is seeking to develop a common good practice framework for integrated commissioning by clinical commissioning groups and local authorities. In thinking about my contribution to that group’s work, I was struck by how much attention continues to focus on a narrow view of integration. Usually, the aspiration is to join up the disparate parts of health and social care, what is sometimes called ‘vertical’ integration.

According to the scoping project for this work, one of the objectives for any new integrated commissioning for outcomes framework is “improving understanding and shared values across health and social care commissioning”. Why not extend that ambition ‘horizontally’ to embrace other services and sectors such as housing?

Last week the Government announced that its promised Green Paper on social care funding - the subject of such angst for the Conservatives in the June General Election campaign - will appear before next summer. I was pleased to note in the accompanying parliamentary written statement:

“Our vision for care must also incorporate the wider networks of support and services which help older people to live independently, including the crucial role of housing and the interaction with other public services. It must consider how care is provided at present and challenge the system to embrace new technology, innovation and workforce models which can deliver better quality and value.”

Intriguingly, it also revealed the experts, ministers and civil servants are sounding out as they shape the consultation document’s content. While those industry leaders on the list are highly credible thinkers around social care and care of older people, I am disappointed that none have the sort of housing background that could provide real insight into housing’s role in prevention and support. Having chaired a housing commission, Dame Kate Barker’s presence on the list offers some hope – as does the presence of my former supremo at the Department of Health, David Behan.

Indeed, as I explained to the CLG Select Committee on Housing for Older People (opens new window) last month, our recent case study report for the National Housing Federation, ‘Home from Hospital’ (opens new window), gives real examples of system savings through prevention. These include facilitating early hospital discharge, reducing A&E attendance and unplanned admissions, delaying a move into residential care, reducing reliance on domiciliary care and supporting people to live independently at home. These are particularly relevant for older people and those with a long term condition.

As someone who is passionate about networks, I believe we need a fully networked system that allows commissioners and providers to bring in that much wider range of services to achieve the outcomes that benefit service users and the wider care economy. The term ‘networked commissioning’ is already in use in the health service but it has a narrow focus on clinical teams for specialties, such as dentistry. We need to repurpose the term.

Inevitably I see housing – particularly specialist housing for older people and other vulnerable people – as the service or sector likely to be of most benefit to those planning and designing the new care landscape.

But we also need to learn from past attempts at promoting integration – for me that includes lessons from managing the Department of Health’s then Care Services Improvement Partnership’s Integrated Care Network more than a decade ago. With this in mind, I see four levers, each beginning with the letter L, that could help us build a genuinely integrated framework.

The first, Language, might seem obvious. Yet professionals and managers from a variety of sectors frequently complain that they are separated from their colleagues by their shared language of English. In sectors - fairly or otherwise - lampooned for their jargon and casual adoption and discarding of buzzwords, we desperately need a shared vocabulary. Communication is at the heart of any network – it is almost the defining characteristic of networks and networking. A streamlined, shared or common language will benefit service users, the public and services.

We can then use that language to (and here comes my second ‘L’) engage in Learning and knowledge exchange. True integration will require us to overcome challenges together and to test and develop new ways of working together.

Allied to that, my third ‘L’ is Listening. This means listening to each other as service commissioners or providers. Rather more importantly we should also be listening to service users and carers. Their views and experiences can improve services generally but they can also highlight opportunities for partnership working and joined-up services. Interestingly, an evaluation of the existing Local Government Association commissioning for better outcomes in social care framework said more attention should be paid to ‘prevention and carers’ and called for a stronger voice for service users and carers.

And, inevitably perhaps, we need Leaders who drive the behavioural and cultural change that will be needed to build our wider network and the services and support that populate it.

Encouragingly, back in 2014 the Care Act placed new duties on councils to cooperate and take a broader view of the care and support market. The forthcoming Green Paper must build on this and think beyond a traditional care economy by setting out a networked approach to meeting the health and wellbeing for people of all ages. Housing cares and it’s time to embrace the four L’s so we can take our L-plates off and create a truly integrated and finely networked system.

"Jeremy's new blog, Beyond the Green Paper: Destination Networked Care"