New organisational forms, planned and developed locally, will help to make integrated care the norm argues John Copps. A version of this article was published in the HSJ – click here.
As a test bed for new models, Vanguards will play a central role in determining the shape of integrated healthcare over the years to come. In many ways, they are the crystal ball for gazing at the future of the NHS and social care.
Two years into the programme, and there’s already much to celebrate. But the challenge is quickly moving to how to translate local examples of innovative practice into something that will work nationally, at greater scale. As Samantha Jones, director of the programme, argued recently, we now need to ‘make “new” care models the norm’.
So how do we go about doing that? What can we do to help the models pioneered by Vanguards succeed elsewhere?
A key enabler is having the right organisational structures needed to support integrated health and social care. As Vanguards know better than anyone, creating the space for innovation requires a change in how all partners in the system do business.
To allow scaling up of new approaches, we need organisational forms that balance freedom to innovate with strong governance and accountability. We need organisations that can bind together different parts of the NHS and social care jigsaw, giving everyone a stake in success and encouraging whole system thinking.
There is already spectrum of ‘non-traditional’ organisational forms that allow NHS and social care services to do things differently. They include companies wholly-owned by the public sector, joint ventures and public services mutuals.
In children’s social care, for example, 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.
Elsewhere, The Health and Wellbeing Limited Liability Partnership (LLP) is a vehicle for delivering integrated health and social care services in the north of England. 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.
Salford-based Social adVentures, established in 2011, is a service-user and staff-owned not-for-profit company delivering public health services to the NHS and local council. Since ‘spinning out’ of the NHS, it has bought a garden centre, which it uses to provide meaningful activity for clients with mental health problems, and a nursery, which offers affordable childcare to local people (and generates a healthy surplus). Both these assets have been transferred from private to community ownership, allowing Social adVentures to provide a more integrated offer to local people.
These models, and others like them, can be a genuine addition to the public service family, maintaining what it means to be part of the NHS but bringing the disciplines associated with being an independent organisation. For Vanguards they can offer the conditions in which their innovations can grow from local projects to national influencers.
As always it’s the result that matter most, and organisation models must be designed to protect outcomes over the long-term and ‘plumb in’ appropriate governance controls. The mantra is ‘function before form’ or, in other words, organisational form must always be servant to the outcome you want to achieve.
The Five Year Forward View demands radical thinking. The NHS is already a diverse ecosystem of providers – but for Vanguards to fulfil their promise, it needs to get even more diverse.
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