When the NHS Five Year Forward View (Forward View) was published last October, its central tenet was that the NHS could not go on as it had. Unless the NHS started to do things differently, it would face a funding gap of approaching £30bn by 2020.
At the same time, the Forward View wanted to improve the service that patients, and service users, experienced, especially when – as was the case for most of the time – they were outside hospital. As the Forward View noted, ‘Even people with long-term conditions, who tend to be heavy users of the health service, are likely to spend less than 1% of their time in contact with health professionals.’
As a result, the emphasis in the Forward View was much more on what happened to people, and how they controlled and experienced their care, during the other 99% of the time. This meant much more emphasis on integration, including between health and social care. How this might work in practice was set out in a number of proposed New Models of Care:
- Multi-specialty Community Providers (MCPs): essentially a form of horizontal integration, whereby groups of GPs could combine with other services, including mental health and social care, to create integrated out-of-hospital support.
- Primary and Acute Care Systems (PACS): a more vertical form of integration, with acute hospitals, primary care providers and other service providers coming together, in forms akin to accountable care organisations now being rolled out in the USA and in other European countries.
- New mental health support systems, achieved through better integration of crisis services and more appropriate use of community settings.
- Enhanced care in care homes, especially those specialising in supporting people living with dementia, with new shared models of support to reduce hospital bed usage and increase quality of life.
Earlier in the year, the NHS received over 260 bids for funding to become part of the first wave of these New Models of Care. This first wave has been given the title Vanguards, and there will be funding to support them, although it now looks like it will be less than the £200m originally suggested.
There are 29 Vanguards; they include six sites looking to provide enhanced care in care homes and fourteen MCPs. They are now getting underway, so it’s useful to look at what they’re aiming to do.
There are two reasons for this. Firstly, because the Forward View is now unassailable as the policy blueprint for the health service, with unequivocal Government backing – it’s the only game in town. Secondly, because although many of the plans are laudable and positive about some care, not all of them as currently outlined make reference to actual social care providers. This is despite providers being central to the success of the plans, and despite there being numerous examples around the country of care providers already undertaking just the kind of integrated service that the NHS is looking to introduce. As such, there is plenty of potential for people on both sides of the health and social care fence to miss a trick or two.
You can find out about the Vanguards and their plans on the NHS England website. Meanwhile, if you’re a social care provider, you need to be aware that these models, or something very like them, might well be happening near you. It could have profound implications for the future of your organisation.
In Gateshead, for example, the Clinical Commissioning Group (CCG) and the Gateshead Local Authority plan to create a new organisation, the Provider Alliance Network (PAN), to enhance social care through delivering the Gateshead Integrated Community Bed and Home-based Care Service, with PAN providing ‘holistic care and seamless support across the traditional health and social care boundaries’. By 2016, PAN and its commissioners expect to see co-commissioning of all services ‘except those in the private sector’. What happens to service provision that is based in the private sector? How will it integrate with what PAN is doing, given that for most service users, it’s irrelevant what sector the care is coming from?
In other areas, the picture is brighter. In Hertfordshire, the Hertfordshire Care Providers’ Association has joined together with the County Council and East and North Herts CCG. They are looking to enhance education and training for care staff, through accredited qualifications and to create dedicated multi-disciplinary teams for care homes. These teams will include GPs, community psychiatric nurses, district nurses and geriatricians, working proactively to support care home residents. The new care model will include rapid response services and better assessment within the home setting as to whether hospital admission is required.
This mirrors the approach already taken by CCGs in other parts of the country, with the NHS funding on-site GPs and pharmacy services for the Nightingale Care Home in south London, for example, and supporting a lead nurse in Shropshire to train and develop staff in care home provider organisations such as Coverage Care.
Likewise, in Sutton, although no social care providers are mentioned by name, there is a commitment to the Vanguard developing a care home provider network to support training across local care homes. Plus a new model of health and social care locally, which will include tele-health and expanded in-reach services, providing the right care at the right time for residents. Again, this is similar to the way the Royal Masonic Benevolent Institution is using telemedicine, especially via video links, to connect staff and residents in care homes with consultants in hospitals.
There is more attention given generally to sharing information and better use of mobile/digital technology. In Nottingham City, where the Vanguard covers a registered GP population of around 350,000 people, the plans include mobile working for primary care; access to SystemOne (the NHS/GP information system) for care homes; remote video consultation between care home residents and GPs; remote access to resident health data through telehealth; and increased use of telecare. The aim is to manage hospital stays better and to support care home residents to leave hospital as soon as they are ready.
There is also much more emphasis on joined-up working across health and care teams. In the north-west, the Fylde Coast Local Health Economy, which is a MCP Vanguard, is planning to create integrated teams of community nurses, allied health professionals, social care staff, mental health workers and teams from the voluntary and community sectors. In particular, they are looking to create Extensive Care Teams for the frail and elderly, so that people can have their conditions managed by a co-ordinated health and social care team, working from a single, shared care record.
Similar plans are underway around the country. As such, even if your services aren’t based in an area that was selected to be a Vanguard area, it’s likely that something like this is happening near you.
Be a part of the change
Social care providers need to be aware and involved. I originally mentioned two reasons for this. There’s also a third. It’s entirely possible that social care will be the biggest loser from the election. The Government has made unfunded manifesto commitments to increasing spending, including finding a further £8bn for the NHS. Having to implement campaign promises means that there will be little wriggle room; it is impossible to compute a solution to tax and spending commitments that does not leave local government and social care enduring further significant spending cuts. As a result, if you’re a social care provider, finding ways to work differently, or to access alternative sources of funding for training and service development, is a priority.
If you’re not yet involved, and you’d like to build better links with your local health economy, here are some things you can do:
- Have a look at the NHS England website to see whether there is a Vanguard in your area.
- Engage with your local CCG(s), local NHS Trusts and other system-wide groups and find out what’s happening – and if necessary persevere until you find an ally.
- If you’re a smaller provider, think about building alliances and partnerships with others in a similar position, so that, for example, you might form a combined offer to provide a range of services.
- Work with your local care association: find out how far they’re involved in discussions around integrated services.
- Social care has long been a source of innovation and community links – don’t be shy about bringing your ideas and your work to the table and promoting them locally.
- Concentrate on building relationships: getting things done, getting your voice heard and getting a seat at the table often depend more on relationships, trust and commitment than formal structures.
- Think about developing your teams to work across systems and sectors; the NHS, especially through its lead nurses, may be a source of training and development for social care staff.
- See yourself as part of the collective leadership of the health and care system in your area, as well as a leader in your own organisation.
Above all, keep going. The Five Year Forward View needs social care if it is to succeed, and social care providers already have hard-won knowledge and expertise in making integrated care a practical reality. It’s time to show the NHS just what social care can offer.
NHS England, New Models of Care Vanguard Sites www.england.nhs.uk/new-care-models
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