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New delivery models take centre stage
Writing for Public Sector Focus, MV Director Andrew Laird explores some of the early successes and lessons learned from new delivery models in children’s services and health and social care.
The government has made it clear it wants to see local areas exploring how they can better join up and deliver services. The Prime Minister, Theresa May, is particularly interested in ideas which look at sharing ownership and accountability.
Let’s look at health and social care integration first. Across the country, reform is being driven by the development of Sustainability and Transformation Plans (STPs). The new care models vanguards preceded the STP process but have set the pace in terms of what can be achieved by services working together in new ways. We are now two years in to the vanguards programme, and there has been some success but the challenge is how new care models become the “norm”.
A key enabler is having the right organisational structures needed to support integration. Creating the space for innovation requires a change in how partners in the system operate. The potential of integrating health and social care is not just about efficiencies and trying to solve the big financial issues facing hospitals. It is also about connecting down – using a wide range of providers including locally based charities and social enterprises. These organisations have fantastic networks and relationships with service users, particularly those who have problems which can be predominantly managed outside a formal clinical setting. This highlights that we need new delivery models that can bind together different parts of the NHS and wider health sector giving everyone a stake in success and encouraging whole system thinking.
Health and social care is not the only area where new models are becoming a serious option. There is an increasing occurrence of shifting children’s services to a more focused “trust” model. Achieving for Children is a joint venture between two London boroughs delivering a suite of integrated services under contract. Working with central government and forging relationships with local health partners, it is now working in neighbouring councils to spread its innovative practice. Sunderland has also just launched its own full service children’s services organisation, Together for Children. Wholly-owned by the local authority, it is run by an independent board and management team whose mission it is to deliver safeguarding, education and early help services on behalf of the council.
It’s not just public sector bodies who are looking at new models. Independent organisations, who deliver public services, are looking at how they respond to the challenges of commissioners wanting to contract over wider geographical areas and across more complete service pathways. Based in the north of England, the Health and Wellbeing Limited Liability Partnership (LLP) is a vehicle for delivering integrated health and social care services. Comprised of eight social enterprises and charities, the LLP has been created to offer commissioners a single entity to provide services along entire service pathways and across a wide geographical area.
So how does this all fit with the opportunity afforded by devolution? With an area covering eight councils and a population of over 4m, the new West Midlands mayor will oversee the second biggest devolution area in the country (after London). The devolution deal agreed to date is mostly focused on boosting the economy to create sustainable employment and how infrastructure projects (like HS2) can support this. The plans for how public services will take advantage of this historic opportunity are less clear.
A number of local authorities in the West midlands are exploring how they can best deliver their children’s services. Work is at an early stage but it could involve looking at the types of new models we have seen in Kingston, Richmond and Sunderland.
On health and social care integration, the situation in the West Midlands is quite complicated. There are three different STP areas in the devolution area, including one which includes authorities not involved in the devolution deal. All these plans are being developed independently with their main challenge being to engage with local stakeholders, never mind neighbours. This complex landscape, make any sort of joined up approach across the West-Midlands very tricky.
Despite this, good progress is being made on mental health, which is a particular issue in the West-Midlands with nearly a quarter of all adults suffering from some form of mental illness. Through a combination of lost working days and treatment, this costs the region £12.5b a year. To tackle this problem, the West Midlands Mental Health Commission was set up – and in January this year it produced an ambitious action plan. They are now moving into implementation phase and this work has the potential to be a trailblazer to show how the public and third sectors can work together to deliver real benefit to citizens. Whoever the new West midlands mayor will be, mental health will clearly be one of their early priorities.
This is an exciting and challenging time for public services. The Brexit process is demanding a lot of time and energy from central government so the burden of domestic public service reform is largely falling to local areas. Whether through the implementation of STPs, the realisation of devolution deals or the exploration of new ways of delivering children’s services, new delivery models will undoubtedly play a big part.