The integration challenge

By Peter Molyneux, Common Cause Consulting - on 28/01/2019

“The NHS and our partners will be moving to create Integrated Care Systems everywhere by April 2021… ICSs bring together local organisations in a pragmatic and practical way to deliver the trip integration of primary and specialist care, physical and mental health services, and health with social care.” (NHS Long Term Plan, p10, 2019)

The NHS Long Term Plan is clear about the potential of Integrated Care Systems (ICSs). So where does social housing fit into this? How can it become part of this integrated approach to health?

Before we start, some explanations around current terminology might help:

  • Integrated care models have been developed in order to co-ordinate care services for a defined group of people, for example, older people or people with complex needs.
  • Integrated care systems have evolved from sustainability and transformation partnerships (STPs), and take the lead in planning for and commissioning care for a defined population. Bringing together NHS providers, commissioners and their local authority partners to improve health and care in their specific area. They provide an opportunity to look at the specific needs of a particular population and determine the outcomes that really matter to those patients.
  • Integrated care partnerships are alliances of NHS providers working together to deliver care, including hospital and community services for both physical and mental health, GPs, and social care as well as independent third sector providers. 
  • Primary care networks are at the core of Integrated Care Systems. They are based around a GP-registered list of 30-50,000 patients, encompassing general practice and other partners in community and social care.

Strategically, there is an important role for housing to play in ensuring homes are accessible, adaptable and well-designed. Simultaneously, these homes should be inexpensive to heat and situated in places where residents can buy fresh food, are able to (and encouraged to) exercise and where neighbourhood cohesion is actively promoted.

Thus far, much of the focus has been on the need for vertical integration between primary, community and secondary providers. With mental health services, however, it’s possible that horizontal integration will be equally important if we are going to achieve the outcomes that service users want. Services like employment, housing and other community services could be just as important as those provided by care providers.

At the levels of ICPs and PCNs there are opportunities for collaborations between providers, with housing and support providers being part of new community solutions. However, housing organisations can also omit to talk about the breadth of what they do whether that is providing housing advice, crisis houses, step-up / step down accommodation, transforming care for people with learning disabilities and extra care housing. They also invest in communities by providing or funding training schemes, training academies, neighbourhood hub and a range of health promotion activities.

One problem is that housing and support providers are often still promoting models that meet a social care need (and the needs of social care commissioners), rather than a health need. This is understandable, as the relationship between support housing and social care has developed over decades. This doesn’t mean that supported housing providers have to become care providers, but we won’t achieve genuine integration if we only meet at the edges.

So, there is an issue is around how we build confidence and trust between health and housing providers. There is a need to be honest and build on our strengths and address our weaknesses. The Care Quality Commission’s five domains: caring, responsive, well-led, effective and safe. From my work with housing providers my experience is that they do a good job with the first four of these. But when health providers look to partner with them, it’s the fifth of these – safe – where housing providers can sometimes come unstuck.

When we talk with responsible clinicians, they tell us that they need to see and understand how a provider is defining risk, and how they are going to develop a shared understanding of risk. They want to see how the proposed provider is observing changes to someone’s risk signature, as well as recording and reporting these changes. All too often, housing providers fail to demonstrate that they are delivering on this fifth domain effectively.

If we want to fully integrate with health, demonstrating that housing meets the concerns of health providers around safety is one of the key challenges we need to meet. Supported housing should be playing a significant role in the future of the health. If it can meet this challenge it will be a long way forward in playing a full role in this new integrated approach to health. Otherwise, the potential benefit of integrated care systems for millions of people, whether they have complex needs, long-term health conditions or are elderly, will never be fully realised.

Find out more about the Integrated care systems: professional development programme run by HACT

Or book your place on our masterclass, Understanding the NHS for housing associations

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health

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