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?