KET 8 Integrated HealthCare University of Birmingham, 25.2.14

Knowledge Exchange Trials 8

I was invited to another government policy forum where the workshop was run under the Chatham House Rule  where comments cannot be attributed to any individual or their affiliation.

Summary of points

The process of how policies are formed was briefly described. Government green papers are generally consultation documents whilst white papers are documents that outline what the government intends to do. The minister will tend to lead on identifying a problem.  S/he will set a deadline for the problem or policy to be written, as the election cycle dominates the timings for policy making. The analyst will conduct an initial survey of the current thinking (research literature) around the issue, which will include a quick chat with “trusted friends” who are academics who become regular but informal advisors on the latest research.

What does Integration mean in the context of Healthcare?

Financial – combining resources present various challenges

Political – The Health and Social Care Act 2012 leading to the fragmentation of the health care via the introduction of competiton

Quality of Care and Improved outcomes  – Providing a strong evidence base

Health and Wellbeing Boards were set up to replace Primary Care Trusts (PCTs) under the 2012 Social Care Act. The boards are meant to refine the process of integration by working with practitioners and ‘pioneers of integration’ in their local areas. It also oversees the Better Care Fund which is a dedicated pot of funding for local integrated healthcare initiatives.

Policy Evaluation

PIRU (Policy Innovation Research Unit) collects evidence for the efficacy of integration. It is tracking the ‘pioneers’ 2014 – 2015 to discover the type of metrics being used to measure performance.

Patient satisfaction is a problematic metric to use because it is not possible to measure integrated care from a patient’s perspective, it was suggested. So it was proposed that policy in this area is very much ahead of the evidence, as there is much uncoordinated activity in this area with lots of different funding pots.

It was suggested that in general the questions asked are not usually the questions that end up being answered, as the evaluative process generates its own set of questions. Timing makes large evaluations challenging as reports need to be written with sensitivity to the fast ministerial turn over. It was suggested that alongside the 3 year large evaluations, short “due diligence” studies could be carried out to act as time limited intensive feasibility studies. In order to carry out these studies, trust and confidentiality are primary qualities that need to be developed between academics and policy makers. This means that the academic’s independence is crucial if they are going to act as a “critical” friend in a trusted relationship. The importance of “organisational memory” is key, as the academic will often have to gently and tactfully remind stakeholders of previous initiatives and their outcomes when a contribution of contextual knowledge is needed in the policy making process.

The importance of Local Government

It was suggested that academics can make a larger impact if they choose to work with Local Authorities. Due to the financial crisis, local Health and Wellbeing boards need the assistance of academics to help them commission more efficient and effective services with the limited funds available. LARIA and SOLACE are good for platforming local research initiatives nationally.

Finally, it was suggested that there was an increase of consortia being set up because local social enterprises are too small individually to win the large contracts for integrated healthcare provision. It is also good for academics to be involved on the boards of social enterprises so that research can be conducted more closely in the communities.

My Reflections

Research projects like MEaP that work with local social enterprises and the Manchester City Council, have the ability to generate important research on the ground in terms of how local services in general can be integrated. Integration in health and social care needs to be widened to consider the impact of other crucial factors such as education, housing and employment, as communities have to navigate all of these issues simultaneously. It seems that the efficacy of providing such fragmented policy thinking has to be called into question because the work being done on the ground by communities themselves is already integrated. However, communities cannot often get support for their organic type of integration because of their ineligibility in certain areas when applying for funding. In other words, they are often not able to lever their entire (integrated) portfolio of activities in support of any one application due to the fragmented nature of the bidding process.

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