Two reports were released today (11th October) which emphasise the importance of working together. The TLAP revised framework for Making It Real is a really welcome update on the well-used and highly valued framework, and includes for the first time ‘WE’ statements, which sit alongside the ‘I’ statements. The framework has been produced under fundamental premise of coproduction, where people with lived experience are at the heart of development. The themes of Making It Real are Wellbeing and Independence, Information and Advice, Action and Supportive Communities, Flexible and Integrated care and support, When things need to change and workforce. The powerful I statements make it clear how people should feel about the services they engage with, and the We statements offer up an incredibly valuable benchmark for people who are working in the frontline, planning services or focussing on strategic development to ensure that there is ‘nothing about me, without me’.
Alongside this, the other report released was the CQC State of Health and Care in England 2018
which tells a tale of a fragmented health and care system, with consistent levels of quality services, often thwarted by a flawed system of integration. Social care providers are struggling to offer high quality services under core pressures of funding and a challenging recruitment and retention environment. Within this context, the CQC have rightly praised some of the excellent leadership, innovation, dedication and high quality care they have identified within care services. However, they have added their voice to the call for a Green Paper that addresses the long term sustainability of the social care sector. The CQC perspective across the whole of health and care has shone a light on the inherent co-dependencies across our fragmented system, and provides further evidence of how futile it will be to significantly invest in health without embedding sustainability and growth in social care.”
There are two ways to view the CQC report. One is a sense of profound deflation. That the incredibly powerful voice of people with lived experience highlighting not only what needs to be experienced, but also how it can be achieved together is drowned out by the notion of an ‘integration lottery’, where key elements of Making it Real such as Flexible and Integrated care and support remain a pipe dream in some parts of the country. Or alternatively, you could take this as a paradigm shift moment. The moment where the key to unlocking the challenge of integration is provided by citizens, rather than politicians or policy makers. That vision that future STP or ACO or even ICS meetings start from the premise that any system that operates across their locality has to meet the conditions of the ‘We’ statements of Making it Real and has to be sense checked against whether the decision makers have fulfilled their part of the bargain– have they done the things that they need to do to ensure that people in communities can feel that they are really getting ‘mu support, my own way’.
I would, of course, favour the latter vision. And there is some rationale for feeling that optimism for the future. The CQC report highlights some important improvements in both the leadership and safeguarding elements of care inspections. It provides us with some insight into excellent models where innovative and integrated services have been developed and are successful, including an opportunity to share the learning from NCF member Accord. It shares the voices of people who have experienced really outstanding care that show the fundamental life transforming potential of person centred care. However, it notes that ‘good, personalised, sustainable care in some local areas is no longer just about whether individual organisations can deliver good care, but whether they can successfully collaborate with other services as part of an effective local system’ yet during their systems review…’in too many cases, ineffective coordination of services was leading to fragmented care.’
We have known for years that We is a powerful preposition – it suggests partnership, collaboration, joining, connection, togetherness, union, collective, shared agenda and much much more. These two reports give us both a motivation to work harder at being ‘we’ and understanding what ‘being more we’ will look like. So as the integration juggernaut rolls forward, the collective cry from people who use services, providers and commissioners should be – integration – yes – but remember – we know what we want from integration – we have a shared vision of what good integrated services will look like - and most of all ‘We wanna be together…’
NCF Blog by Vic Rayner, Executive Director, National Care Forum