The National Audit Office’s recent report on the integration of health and social care confirms what many already know; that progress on integration – through the better care fund principally, but also the new models of care and the sustainability and transformation plan processes – is much slower than it needs to be.
This raises questions. Is the expectation of the speed of change too great? Are we going about it in the wrong way? Will we make it in time, and what are the consequences if we don’t?
Samantha Jones, NHS England’s lead on new models of care recently tweeted … “I’m banning the words ‘scale’ and ‘pace’ … it only works as fast as the relationships allow it to happen”. The NHS is having to build relationships like never before and it is taking time to develop the networking skills, the understanding and the trust.
The fact that there are more ‘points of light’ emerging – for example, Southwark and Lambeth, Wigan and Greater Manchester, Nottinghamshire, and Somerset are moving faster than most – suggests that this is indeed doable. Rather than looking to the centre for guidance, these ‘fast-track’ places are forging their own paths, setting their own frameworks, bending the rules and, most importantly, going into partnership with communities to work out how to create health – in other words they are being disruptive and challenging the system. This takes a different sort of leadership to what the NHS is used to – less controlling, more facilitative and dispersed – and developing those skills does not happen overnight.
Whether we’ll make it in time depends on what you believe is driving the deadline; the cuts in local government budgets? increasing demand from an ageing population or growing inequality? the failure of government to come up with social care funding regime? or Brexit and the accompanying changes in our economic future (whatever you believe they may be)?
Whatever is driving us all we need to look to the best, learn quickly, have tenacity and be brave. Because with renewed and worrying talk of charging for health services, the consequences of not making it do not bear thinking about.
Merron Simpson, chief executive, New NHS Alliance
New NHS Alliance is a social movement for health creation with a mission to ‘infect the health and care system with wellness’. Membership is free and members are drawn from many professions – including social care, health, housing, fire service, education – and from communities themselves.