‘Horizontal integration’ between services who have not worked together so closely before is now on the agenda for the whole health care, voluntary and community system. Primary care can then more easily tap into the specialist community providers. Meanwhile the ICP (integrated care partnerships) and ICS (integrated care systems) bring the whole system together including hospitals, primary and social care. The allied professions sit more strongly in some parts of the system and will now need to adopt new partners and ways of working to use their time and resources more effectively. Much of this will involve learning and embracing change. A culture of trust and positive relationships needs to be actively worked on to enable this, in particularly involving the people closer to the coal faces, as they often have the practical solutions. Top down management structures that constrain people into silos can be impediments to change.
Thinking, for example, of enhanced care in care homes, in order to increase quality of life and reduce unnecessary admissions for people at the end of their lives; this requires quality partnership working, co-operative relationships, collaboration and flexible working structures. Empowered staff can create the new ways of working and involvement is needed right across all forms of care provider, including the care home and home care sectors. These services have been left very much in the cold and viewed as the ‘cinderella’ but now should be essential partners in this vision of seamless support across traditional health and social and other boundaries. It also requires new ways of how professionals are working and who they work with such as skilling up communities and involving the voluntary sector imaginatively. Examples of creative ways of getting messages to the public includes Making Every Contact Count training for public-facing High Street services and care agencies, where people spend time with customers we have found works well in Cranleigh where it has been tested. Getting messages across can include the use of other topic focused learning cafe’s in public places and local social media where information can be simplified and presented in small digestible bites.
Creating learning organisations, such as in care homes for proactive care approaches will help to embed new learning as additional training is provided to skill up the workforce and community in reablement, prevention and rehabilitation. They can also become a local resource rather than a remote place that is only used in times of emergency .
Using technology more intelligently such as telecare communication systems and monitoring of vital signs, such as the use of innovative community prevention approaches used by Care Rooms (www.carerooms.com), Smart Houses using technology to simplify lives will also be important. Involving the independent providers including the domiciliary front line workforce is essential. The intelligence they have gathered through observation and experience needs to be captured and developed further with additional skills to keep people well and independent.
New types of leadership, facilitation and management structures will be required to enable this to happen in a sustainable way.