Collaborative Healthcare – new report

Last month in his Comprehensive Spending Review, Chancellor of the Exchequer George Osborne announced a £10bn funding package for the NHS.  We and the like-minded organisations we often work with believe that the NHS now needs to invest in innovations which have often been developed by social and community care organisations, but which also have huge potential as new approaches to healthcare. Often these models involve health professionals letting families and communities take the lead, with the professionals providing their expert input and back up when it’s needed. Here, my colleague Sue Eley (who leads on developing Shared Lives for older people, as breaks for family carers and as intermediate care), guest blogs about the report:

Today sees the launch of new publication from Inclusive Change, a partnership between In Control, Community Catalysts, Inclusive Neighbourhoods, Inclusion North and Shared Lives Plus, with support from user-led organisation CHANGE; NHS England; Think Local, Act Personal; and the Coalition for Collaborative Care.  The report, Collaborative Healthcare looks at ways in which asset and strength based community services can have a positive effect on the well-being of the people involved, bringing significant health benefits to individuals and neighbourhoods.

Through a number of case studies, the report describes initiatives which have helped people to live ‘good lives in good places’ – the overall aim of Inclusive Change.  By working at a local level, involving citizens and leaders, improvements have been achieved in many aspects of people’s lives, one of the most striking being people taking more control over their own health needs.

Some of the case studies have shown how, by feeling more connected and involved in their communities, people have lost weight, given up smoking and reduced both medication and their reliance on health services generally.  This in turn has led to significant financial savings for local health services, particularly for Clinical Commissioning Groups (CCGs).

Many of the case studies highlight what can be achieved with a little investment and the startling results some of these interventions have had on neighbourhoods that have previously been considered to be ‘problem areas’.  By focussing on community led solutions and involving people at every level, this report shows how much can be achieved.

Here are five key messages from the report:

  • Personal Budgets alone do not create new choices. There must be an equal focus on building new kinds of intervention, workforces, services and enterprises.
  • Many of the people who could gain most from tailored support need the most support to make choices. Support to make real choices needs building into every interaction with services. Advocacy and brokerage are vital.
  • People struggle to co-design creative solutions in a system which focuses primarily on need and money. Individuals, families, communities and professionals need to learn together how to recognise and build upon their collective assets, capabilities and potential.
  • Choice and control at an individual level needs to be matched by shared responsibility for decision-making at the community and whole-area level. This is not achieved through traditional approaches to consultation or including a patient on a committee, but only through co-production: collaborative conversations right from the start.
  • Services are vital, but they are often only one part of a much wider eco-system of support which includes the contributions of family carers and communities. Almost every intervention can be delivered in a way which results in individuals and their families being better informed, more connected to those around them and more resilient.

The report can be found at http://sharedlivesplus.org.uk/information-and-publications/item/251-inclusive-change-release-collaborative-healthcare-supporting-ccgs-and-hwbs-to-support-integrated-personal-care

 

 

 

 

The Connection Test

We’re pleased to have joined the Coalition for Collaborative Care which is attempting to embed models of collaborative care into the NHS. This blog is based on my recent blog for the C4CC.

Partly driven by the necessity of redefining what public services can do during austerity, a consensus is building that public services are not something that ‘professionals’ do to ‘patients’ or offer to ‘customers’, but are increasingly built on the success with which responsibility, knowledge, resources and – ultimately- power can be shared between people or families with long term support needs and workers who bring expertise, skills and kit, but who can’t magic up long term health and wellbeing for another person.

We’ve joined the C4CC because the need for collaborative care is a strong argument for collaboration between the NHS and the voluntary, community and social enterprise sector, of which we are a part.

Developing collaborative approaches is also a challenge to our sector: does every charity and social enterprise have the kind of close, trusting relationship with individuals and their communities that our sector claims? How do you maintain a strong connection with a community if you are a very large national charity for instance? Some national charities demonstrate that they can combine the clout of being big with the ethos of being localised, but good local relationships can’t be assumed, just because an organisation has a charity number.

It’s also important to understand that whilst collaborative models of care are a strength of charities, community groups and social enterprises, ensuring those models ‘get into the water supply’ (as Canadian social entrepreneur Vickie Cammack puts it) of public services can’t just be the role of our sector. We need a way of building the expectation of collaboration into every contract for every kind of service, whether public, private or not for profit, so that it becomes core business and embedded into all commissioning.

In the absence of a better term so far, I’m calling this expectation, ‘the connection test’ and it’s a test I believe should be universally applied across public service provision and commissioning. The test would be something like this:

Does this intervention or service leave each individual, family or community it is offered to:

  • Better informed (or mired in jargon and bureaucracy)?
  • More confident of their own capacity and more resilient (or more reliant on outside help and expertise)?
  • Better connected to those around them (or with new barriers between them and their family, friends and neighbours)?

It’s easy to see how many charities directly try to achieve these goals, particularly where they are delivering community-based initiatives. Adopting these tests universally would help to drive resources towards such initiatives, because each test is harder to pass, the more institutionalised or industrialised a service becomes.

However, every intervention, and particularly every intervention which is intended to be long term, can pass or fail the test: it can be delivered in a way which is confusing, undermining and isolating, or in a way which shares knowledge, resources and power, which aims to minimise its negative impacts upon relationships and connections and where possible, to support those informal support networks. So, for instance, an intervention may be possible to deliver closer to home, rather than in a distant building, or a team working with an individual can make the choice to share formation and expertise with family carers and to be contactable in an emergency. In some cases, those kinds of choices may make a service cost more, but that cost needs to be set against the costs and benefits of sustaining the individual’s independence or a family’s ability to care.

The ‘customer service’ paradigm for public services is over. Continue reading