Extract from Jo Pritchard’s speech to the Building Health Partnership’s Conference on working across systems and building partnerships to deliver more effective health and care outcomes.
Prior to working with Social Enterprise UK, I had many years running a social enterprise, the first to emerge from the NHS back in 2006, it provided (and continues to provide) both children’s and adults community health services across parts of Surrey.
As I look back at those years of delivering health services I am clear that the best services were usually delivered in partnership with others. We came together in partnerships because we believed that it was the right thing to do, services became more seamless and more innovative, and it was the best way to maximise the limited resources we had. These reasons have not changed, but the challenges are increasing.
There is no-longer an option not to work together: the challenge is too big
We know that the need for health and for social care has increased considerably in the last ten years. More older people need support, more working age disabled people are living longer, there are more social and environmental issues linked to increased mental health crises, homelessness, drug related deaths and poverty amongst those in work as well as those not. And there has been a leveling of life expectance and a worsening gap in morbidity and mortality figures between people living in different parts of the country. The Health Foundation reported that a man living in Kingston upon Thames will have 10.2 years more of healthy living than in Manchester.
ADASS reports that although approximately a million people are receiving social care funded by the state, over 350,000 are thought to pay for themselves and 1.4 million are not getting the help with daily living that they need. Age UK claim a 72% increase since 2010 in the number of older people with unmet needs. And one in six of us, that is 7.3 million people, are providing unpaid care for adult family members in England.
On top of this we have a workforce crisis. Vacancy rates in social care stand at 8% (that is 110,000 posts) with 30.7 % turnover meaning that the very viability of many services is threatened by the lack of care staff. And we currently have 40,000 nursing vacancies which is also impacting on the ability to transform services to fit with the NHS’ Long Term Plan ( NHS LTP).
Essential for organisations to come together to develop and deliver solutions
The NHS LTP has a central premise that health organisations will work together in local places to provide integrated care. The new Integrated Care Systems and the Primary Care Networks are envisaged as the way to improve the use of health resources, streamline services and encourage partners to work effectively together to improve health outcomes for the population.
The focus is largely on health providers, with a nod to social care. However, in such challenging times it feels essential that organisations come together to use their different areas of expertise to innovate and to provide new solutions to some of the most intractable problems. It is in times of real difficulty that we are forced to think differently and to involve a wider group of partners (be they in housing, criminal justice, education or any other relevant area).
It is also important to use the local expertise of small charities and social enterprises who know their localities and communities and can respond to local need. From personal experience, I feel social enterprises are well placed to do this as their cultures are ones which make them automatically outward looking as their missions require them to work with local communities to add value. We know that working in partnership has to be the way forward, the only way of achieving the best outcomes for the people we aim to support.
Use the opportunity to include a more diverse group of partners
In the local Building Health Partnership work one of the essential factors is identifying the key partners who together can really make a difference and drive the local change that is needed. People tend to start with their statutory partners when thinking of partnerships, but there is a risk that others can be missed. This decision is often influenced by funding streams: so it is much easier to involve those already with funding for the service under discussion. However, social enterprises and charities can operate flexibly with relatively small amounts of funding and provide impressive outcomes to support partnerships.
For anyone seeking to work in this way you find that local situations require tailor made solutions from a group of partners. Some of the key organisations in various partnerships have been the charity providing lifts to carers as part of the pathway to improve end of life care: we had the hospices, Marie Curie, MacMillan, community nurses and GPs all as key partners but it was being able to get around that helped families a huge amount. And when we looked at keeping people independent at home for as long as possible it was Age UK’s visiting service which alleviated loneliness and was as important as the health promotion and improved aids.
Some of my learning as to how to best develop effective partnerships is to:
- Be open minded and think laterally
- Ignore my preconceptions as to what organisations can deliver
- Invest time in developing relationships with a wide range of partner organisations – you never know what opportunities might arise
- Check out understanding of words and phrases as different organisations use different definitions/words/culture – the word “integrated” caused wonderful confusion in a multi agency meeting a few years ago once we checked understanding around the table
- And, as always, never be complacent about the level of communications
For further information on working collaboratively in health and care see https://www.ivar.org.uk/transforming-together/