Lessons from experience of integration


by Dr Ellie Roy, Health and Social Care Policy Manager

CIPFA/HFMA held a joint conference on health and social care on September 19 to bring together finance professionals from health and local government, as well as providers, policy analysts and managers involved in the sector. Given the current climate it is perhaps not surprising that the programme focused on integration. Despite the fact that numerous summits and conferences have covered this ground, surely there can't be much left to say? Well it appears there is... the issues remain complex and the circumstances in which this important area needs to progress keep changing. The conference showcased some valuable experience, from a range of perspectives.

With the NHS working on a ten-year plan and better integration of health and social care stated as a priority, a Green Paper on adult social care expected in the autumn, and the ongoing experience of the existing STPs, ICSs, and other acronyms involved, integration remains a hot topic on agendas across the sector and beyond. The conference gathered together speakers to share their experiences of integration and the challenges involved, from a range of perspectives.

A focus on children's service was provided by Amanda Allard of the Council for Disabled Children, looking at the progress and future of joint commissioning arrangements and the opportunities in terms of both reducing costs and patient satisfaction.

Representatives from Nottinghamshire shared their experience of the impact of housing on the integration agenda. Clare Skidmore from the Housing Learning and Improving Network shared experience and evidence from the Nottingham experience of Improving health through the home. Jill Finnesey of Mansfield District Council and Marcus Pratt of the Nottinghamshire ICS presented the ASSIST programme aimed at improving the transition from hospital to home, and shared some of the evaluation of the programme and the impacts identified.

Jessica Williams and Tom Wilkinson from Tameside and Glossop shared the benefits and challenges of integrated commissioning in their patch of the Greater Manchester area, where they are ahead of the integration curve in terms of moving towards a single system. There they have been leading the way in terms of integrating commissioning responsibilities by the development of new governance arrangements between the Council and CCG. They told of their Strategic Commission, bringing together political, clinical and managerial leadership to facilitate single decision making on the majority of Council and CCG spending. Key to their approach is a place-based focus with health and wellbeing outcomes at its core.

Aileen Murphie presented the findings of the NAO report on the interface between health and social care, which assessed the barriers preventing health and social care from working together effectively. The report looked at local examples of joint working and identified key challenges, including: financial pressures; cultural and structural barriers; and strategic issues, including a lack of public understanding around social care. These challenges reflect common themes emerging from similar works.

A different view on integration was presented by representatives from Bradford, where an integrated, whole system approach is being taken in relation to mental health first response services.  This multi-agency collaborative project involves commissioners, providers, the police and local authority, as well as The Cellar Trust, a voluntary sector partner. The project has demonstrated success in eradicating out of area acute placements, but has experienced considerable difficulty in securing sustainable funding streams.

Overall the day was enlightening and enabled a wealth of learning from the experience of the speakers. It showcased the fact that integration can be successful, albeit in pockets, and that the wider sector can learn a lot from existing good practice. The speakers were uplifting in their enthusiasm and passion for making their projects work, although the recurring theme of challenges around securing sustainable funding and navigating the financial frameworks show there remains a lot to be done.

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