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Recommendation: Support the vision of NHS five-year view and

promote personalisation as a way of driving integration from the

bottom up. Additionally, to move towards joint commissioning

of information and advice services across health and social care


Impact: This would:

• Bring commissioning responsibility down to the individual level.

• Improve health and social care outcomes.

• Require less intervention from local government and the NHS.

4.7 Bringing together NHS and care leaders at the local level

Our survey showed very strong support (85 per cent) for a joint training programme

for NHS and wider public sector leaders. There are many examples of similar such

programmes, e.g. the Leeds Castle Leadership programme and the Government's

Commissioning Academy (introduced in 2013), but the necessary move towards

strong integration between health and social care sectors necessitates a more

widespread approach. There are examples of this locally: Hertfordshire has a

multi-agency commissioning academy, which every commissioner in the county

will go through, but should be rolled out nationally as an essential part of ensuring

that leaders "speak the same language", as one interviewee put it.

Recommendation: Government to support local areas in

establishing local commissioning academies, of an appropriate

scale, building on existing models. This would involve mandating

local health commissioners and critical providers to attend.

Impact: This would:

• Improve communication and co-ordination of services at the local level.

• Build trust across the health and social care sectors.

4.8 Greater understanding in NHS of care options available

While Government has recently announced a 'What Works Centre for

Wellbeing',125 this is envisaged as a university research-based centre, focused

on long-term evidence of "the impact that different interventions and services

have on wellbeing." While this is helpful, several of our interviewees highlighted

an urgent need for greater understanding within the wider NHS (and, to an

extent, within local government) of what alternative options are available in the

community. This could, for example, include better training of 111 operators so

that they are better at identifying those cases that do not require acute care -

for example, those for whom a visit to a community nurse or approaching their

council about social care would be the best response - and so reducing pressure

on A&E services.

Our survey of local health leaders revealed that the main underlying cause

of delayed transfers of care was due to the relationship between the relevant

partners- identified by 52 per cent of respondents. Delayed transfers of care from

hospital for old people would be reduced if the NHS had a greater knowledge,

communication and understanding of local specialist housing and housing with

care within the NHS.

While an increase in cross-sector training, as proposed above, would improve

local understanding, arguably more is required at the national level. We therefore

propose a practical, NHS-focused centre to promote the latest understanding that

125 Public Health England, "What

Works Centre for Wellbeing

announced" (29 October 2014)

Chapter 4 - What Are Our Proposed Solutions?



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