It’s great to learn from the HSJ’s “CCG Barometer” that CCG leaders are up for change and particularly enthusiastic for integration. So are we, once there is a clear answer to a key question: “who is meant to benefit from integration?” It can’t be only, or even mainly, commissioners and providers. What service users want is coordination and continuity of services. Whether they are “integrated” or not is less important than how they are received and their responsiveness. So the question is “integration for whose benefit?” If done for the “wrong” bureaucratic, institutional or financial reasons and without user and carer engagement from the outset, then the results of integration could turn out to be anti-competitive and anti-user and carer choice.
Can practitioners think and deliver what’s needed?
Integration of services makes good sense for people with complex needs and for those using health and social care (old people, long term conditions, kids) – so vertical and horizontal coordination across all services is needed.
The biggest problem is that we don’t have enough practitioners who think and work like that. They are boxed in by culture and institutions and shot-term management objectives. So just changing structures will not do much good, even if it is possible and affordable. Of course, doing nothing is also not affordable. For a start practitioners need to be liberated to think and work towards “people powered health” changes.
You can’t integrate without engagement
There is lots of interesting stuff in the HSJ’s Barometer report, but look as I might I could find nothing in the questions or the responses – please tell me that I have missed it? – about engagement with patients, carers and communities.
Building public support for change (eg the big challenge of decommissioning and reinvesting), community development and capacity building to enable collective shared decision making are essential if integration in the right way is to be achieved and sustained. If those things don’t happen, CCGs won’t be the only people left whistling in a very chill wind indeed as the resources dwindle.
It’s about leadership – first, last and always.
Changing professional attitudes and practice to commission and deliver coordination from a user perspective requires leadership and persuasion, not just initial enthusiasm.
Let’s hope CCGs are up for that too, so that the barometer doesn’t veer from “fair” to “stormy”.
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations. Feel free to contact us to discuss the opportunities.