Professor Martin Green OBE, Chief Executive, Care England
If we are going to get the care and support right, we must understand that it cannot be done by organisations and institutions sitting in silos and not connecting with one another. One of the greatest complaints I hear from people who use services is that they often experience services that sit in silos and do not connect with each other. This lack of connection happens on every level. We often see services not transferring information between one another, we see decisions being made in vacuums often without the involvement of the person using the service, and we see a labyrinthine funding landscape that means that people often fall between health and care, and the ensuing battle over who pays for what leaves people frustrated, angry and without support.
This is well-known, and there have been so many attempts to deliver integration, and we are currently seeing yet another structural change with the arrival of ICSs. There is a hope that these new structures will deliver more integration and better outcomes for people who use services.
Understandably many people who use services are sceptical about this new approach, mainly because they remember we have been here before. Over the past 30 years, we have seen so many new structures, all supposedly going to deliver integration. I can remember the co-location of health and care teams; I can remember joint appointments between the NHS and local authorities; we have had PCT CCG’s Health and Well-being Boards, and a range of other local initiatives, all of which promised an integrated system, but none of which, delivered real integration.
If we are going to move to a much better place, we have got to first engage with the people who use services and their families. If collaboration means anything, it should start with the person who uses the service, their families, loved ones and networks, and the services that are provided by either health or social care should work collaboratively with all the skills and resources the person has, to deliver the best care and support possible.
Our system is not so much a health and care system; it is a crisis system where people get support, mainly after a crisis. We also have a system that works on people’s assets, not their deficits. To have truly collaborative care, we should start by looking at people’s strengths and finding ways to support them to live well and maintain as much autonomy, choice and control over their lives as possible. We also need a system that collaborates with families’ carers and loved ones in ways that enable them to take on as much (or as little) of the caring responsibilities as they feel they can.
We need to start from a different place if we have a truly collaborative system. We need to understand how to deliver support that enables people to maintain their independence, rather than waiting until they go into crisis and putting in interventions and support often when it is too late. If we get this right, it will be better for citizens, the taxpayer, and everyone.