Joining forces for Integrated Health and Care
The advent of the Integrated Care Systems should be an opportunity for organisations across sectors to join forces in a way that was not possible before. But it all seems a bit daunting. ‘So how should this best be approached?’ was the question we explored in this meeting.
Our first speaker was Samira ben Omar, previously Head of System Change at the North West London Collaboration of Clinical Commissioning Groups, and now working independently.
Our second speaker was John Mortimer, previously at Vanguard Consulting, now also working independently.
Here are some of the key points made by speakers and in discussion:
The formal health system cannot bring about good health by itself. 80% or more of the drivers of health are elsewhere. The NHS needs to join forces with others.
There are serious problems of health discrimination and inequality, made more evident during the pandemic. So when joining forces, it is always necessary to consider who is included, who needs to be reached, and what discriminatory policies or practices need to be tackled.
It is important to unlearn, in order to shift towards a more creative and relational set of practices. In particular, we need to move away from the proliferation of committees, which have often become a ‘place of performance’, rather than drivers of improvement or change.
Instead, we need to establish new spaces for people to come together to share power, from neighbourhood level upwards. The ‘Us & Them’ culture is toxic in the health system. We will only address that if we create more opportunities for people to discover their shared humanity.
It is important not to make assumptions about what people want. Instead, we need to shift the whole system towards person-centred design. This includes asking open questions, listening together, bringing back answers. It also means giving front line teams the freedom to organise their work differently: to understand at first hand the experiences of individual people in the system, then experiment, prototype, and make normal.
Public sector organisations need to ‘let go’ more. Communities do most when they can decide for themselves, it was said.
We need to remember that in partnership working the quick fix is never successful. Worthwhile change will take time, and commitment must therefore be long term.
We need to resist pressure from NHS England or elsewhere to meet immediate targets, and we should be wary of putting too much faith in new structures. It’s the shared purpose held by committed people connecting across organisations and sectors and hierarchies that will get the best results.
New Public Management, with its fixation on target-setting, cannot co-exist with Integrated Working, which needs the freedom to practice relational methods. The former has failed to drive down costs and improve health outcomes - the latter now needs to be given a chance.