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Fiona Johnstone: Lets' get cracking on integration

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Wirral has recently been successful in bidding to become a vanguard site for the national Five Year Forward View programme developed by NHS England. This puts the region at the forefront of the health and social care integration agenda, and raises a number of questions about the future design of service provision.

It is not in our nature to enjoy uncertainty. The myriad strategies, policies and procedures that we health and social care practitioners create and force ourselves to stick to when providing or commissioning services are there to guide us – to guard against uncertainty.

So it is surprising to be able to write that one of the things I am most looking forward to about the future of integrated services is exactly this uncertainty.

Our partners on the programme include internationally recognised providers from the US, and internationally recognised bodies that specialise in the creation of the new systems we will need, all the way from research to the IT we will commission and how we will evaluate performance. We are encouraging ourselves to forget the structures we currently exist in, and to focus on what we want to achieve, letting form follow function – no easy task when the first instinct is to ask how it might affect particular organisations.

So what will be the role of commissioning? How will we be able to redesign while continuing to be bound by EU rules around procurement? How can we link into our designs the factors that really influence health – the quality of where someone lives, their opportunities to work, social prescribing and mental wellbeing? If the new world is to be successful, these need to be at the heart of our planning.

On Wirral, we have already been working with our local health partners to design a new health and wellbeing model, bringing together local providers, CCGs, local authority teams and service users with people, not organisations at the centre.

There are some things we know we need to do. We know that our existing system is unsustainable, and not as efficient as it could be. More care needs to be provided upstream to help with the increasingly ill but longer living communities we serve. We need our communities to care about their health, even when they aren’t ill.

More care will take place in the community, provided through collaboration between different skills sets – let’s avoid talking about ‘primary care’ providers and ‘secondary care’ providers if we really mean this. How fantastic would it be if we manage to free up our workforce to make the most of the skills they have?

We know what we need to achieve. The word integration has been bandied around for years now, and in the meantime those of us who are expected to deliver it have debated exactly what it will look like. We’ve seen some beacons of success. 

I’m writing this in spring, a time of hope and new life. We’re going for it on Wirral. Let’s get cracking.

Fiona Johnstone, director of public health, Wirral MBC

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