Guest blog by Professor Steve Field, Chief Inspector of Primary Medical Services and Integrated Care at Care Quality Commission (CQC).
In the 70 years since the National Assistance Act and the new National Health Service established the modern welfare state, our health and care needs have changed and grown.
In 2018, we expect people to experience personalised care that is tailored to their individual circumstances and joined-up to meet their needs. And we understand that people should be active partners in decisions about their care. For people working in health and social care, the task has rarely been more challenging, complex and uncertain. Trust and collaboration between health and social care organisations have never been more important. This means that a system designed in 1948 can no longer effectively meet the needs of increasing numbers of older people with complex health and care needs.
In CQC’s review of care for older people in 20 local systems in England, we worked with organisations that represent people who use services. National groups, including the Richmond Group of Charities, provided input to our advisory group. Local voluntary, community, and social enterprise (VCSE) engagement was built in to each review from week one when we made a call for evidence to relevant voluntary sector organisations. For example local Healthwatch and local Age UK, carers organisations and dementia cafes. On the first visit to the area we went to see many such organisations.
We found that the VCSE sector is under-used in the planning and delivery of services and often not seen as partners. Health and care commissioners and providers, including the independent sector, must share risk and work together as a unified system.
We found that people experience the best care when people and organisations work together to overcome the fragmentation of the health and social care system and coordinate personalised care around individuals. This is already happening in some places, but we must remove the barriers to collaboration at a local and national level and incentivise joined-up working.
If we are to make integrated care a reality, we need to change the way we measure performance, approach funding, plan the workforce, and regulate services. The NHS and social care are two halves of a whole, very often providing support for the same people.
We must create an environment that drives people and organisations across health and social care to work together, rather than driving them apart.
We need to move away from efforts to measure the performance of individual organisations working separately. Local and national leaders need a single, shared approach to measuring how well their whole system meets the needs of people using health and social care services.
We also need sustainable funding reform, supported by long-term investment and greater flexibility that allows local systems to make the best use of their resources to meet the needs of local populations.
We need an approach that supports collaboration, rather than imposes limits on how far local government and NHS commissioners can align or pool their budgets. Joined-up care also requires a workforce equipped to move between health and social care. Workforce planning needs to create the skills and career paths that allow people to work flexibly across the system as services evolve over time to meet the population’s changing needs.
Efforts to join-up a fragmented health and social care system must be recognised and reinforced by an improved regulatory framework that looks at the whole system, as well as the individual organisations within it. For CQC, this means we want the power to look at the quality of care across a system, as well as in the individual organisations that provide health and social care services.
These are difficult problems to solve. There have been attempts to integrate health and social care since the 1970s. None has yet fully succeeded in overcoming fragmentation and achieving joined up, personalised care for individuals. But it is clearer now than ever before what needs to be done to address this great unresolved challenge. The question that remains is whether leaders working locally and nationally have the bravery and conviction to lead the charge.