John Copps argues that it will be NHS and local government leaders that make integrated care work, not Westminster law-makers.
One of the landmark pieces of legislation due this year is the long-anticipated Health and Care Bill. The Bill will cover a lot of ground but a core part of its purpose is to mark a shift to more joined up working within the NHS, and with council-run social care services.
It is set to sweep away some of the rules that make working across organisational boundaries unwieldy and establish a statutory grounding for system-level and 'place' partnerships. If you accept that integrated care is the right direction travel, this is all good news.
But it is tempting to overstate the importance of legislation. Instead, it is a good time to remind ourselves of the limits of the law: whilst it can change how we behave, it can’t guarantee that those new behaviours will change anything.
In the context of integrated care, this is another way of saying that you can’t legislate for successful collaboration. For integration to work it needs genuine partnership, a shared vision and an agreed plan.
So, what should NHS providers be thinking about before the proposed changes become law?
First, providers need to invest in the relationships that they have and ask what else they should be doing with colleagues. When approaching these conversations, an understanding of the value that each partner brings is vital. Leaders also shouldn’t ignore the history of the relationship between organisations – they should address it head on. Although the emphasis on collaboration provides a chance to do things differently, in some places this will be quite a gear shift. After twenty years of providers competing, the transition will not be easy.
Second, providers should look to examples elsewhere, and learn from what they have got right and wrong. Mutual Ventures has supported provider collaboratives in Essex and South West London, and is currently working in Barnsley. These areas have taken advantage of opportunities to work together including through standardising clinical policies, sharing estate, developing better career structures and progression for their staff, and creating joint corporate teams.
Third, successful partnership is about doing what works for you and your partners. No two places look alike and local ‘place’ arrangements vary widely in terms of membership and priorities. Helpfully, the Bill is unlikely to prescribe what collaboration looks like, and it will be up to providers to decide what suits local circumstances.
When the Health and Care Bill passes into law, it won’t be a revolutionary moment. Rather, it is part of a gradual shift of momentum in the NHS from competition to collaboration. The relationship between patient and service has always been at the centre of the NHS, and perhaps the most significant change in the Bill is to recognise that relationships between services must play a bigger part in this.
Read more about Mutual Ventures’ work on collaboration in the NHS here.