Following our last article on the importance of data in decision-making, we now focus on the delivery of place-based solutions. Why is it important? Has it been done before? What is the role of the estate, and how is this evolving?
The idea of ‘place’ in this context means making decisions as close to the population as possible to ensure that locally-identified needs are addressed, rather than adopting a top-down or ‘one size fits all’ approach that dismisses local needs, such as those associated with demographics.
To be most effective, strong partnerships and effective collaboration between those who are responsible for arranging and delivering health and care services are needed, and a fit-for-purpose estate is key.
England’s 42 Integrated Care Systems (ICSs) came into being in July 2022 to address this at a local level through place-based solutions. Stakeholders involved in delivering these solutions locally include integrated care boards, acute and primary care providers, the local authority, social care providers and community groups.
Overall, a lot has been learned from the COVID-19 pandemic efforts. Below is an extract taken from the Executive Summary of the Government paper: ‘Health and social care integration: joining up care for people, places and populations (published 11 February 2022):
“There is a lot for local government and the NHS to be proud of and to learn from as we move into recovery from COVID-19. Through multi-agency community hubs, integrated neighbourhood teams, and other locally developed arrangements, local partners developed a shared understanding of local needs and made flexible use of resources across services to ensure that people got the support they needed."
"Successful integration is the planning, commissioning and delivery of coordinated, joined up and seamless services to support people to live healthy, independent and dignified lives and which improves outcomes for the population as a whole. Everyone should receive the right care, in the right place, at the right time."
SO HOW IS THE NHS ALREADY DELIVERING PLACE-BASED SOLUTIONS?
There are a number of examples of Trusts and Councils that have already implemented collaborative place-based solutions, tackling health inequalities and promoting healthier lifestyles for the communities that they serve:
ONE YOU KENT
Kent Community Health NHS Foundation Trust has been promoting and providing the community with tools to implement a healthier lifestyle through the 'One You Kent' scheme. In collaboration with Ashford Borough Council and Kent County Council, the Trust launched the first One You shop in the Park Mall in Ashford. The premises were provided by Ashford Borough Council, Kent County Council funded the One You service, and the Trust financed the refurbishment of the shop and operates it.
CAMDEN ADULT PATHWAY PARTNERSHIP
comprises a project initiated in 2021 that was funded by the London Borough of Camden and North Central London CCG and delivered by University College London Hospitals NHS Foundation Trust (UCLH). The project is aimed at single homeless people with complex needs. The project started in four hostels run by the London Borough of Camden and will gradually be expanded to 15 during the life of the project. UCLH will provide a team of clinicians, managers and an administrator who support and work in partnership with a number of services such as the voluntary and community sector, substance misuse treatment services, mental health, primary care and other health and social care organisations to deliver integrated and coordinated care to tackle health inequalities across the Borough.
HEALTH AND WELLBEING CENTRE
In October 2022, Kirklees Council opened a new Health and Wellbeing Centre in Slaithwaite. The space for the centre was provided by NHS Property Services. The centre will work towards tackling health inequalities by providing personalised care services, including social prescribing and health and wellbeing coaching. It is also intended that the space, which is operated by the Council, will be used by other local groups to provide additional health and wellbeing activities.
These examples illustrate three local health systems that have understood the health and wider issues impacting their populations and the actions taken to address these issues. It is also clear that partnership working and choosing the right location have been crucial to their successful delivery.
There remains an important role for the healthcare estate in physically supporting the delivery of place-based solutions, whether that be the delivery of new buildings, occupation of under-utilised retail or commercial space, reimagining existing public spaces or reconfiguring existing health space to accommodate a variety of health and social care services.
And in an evolving world of sustainability and carbon reduction, the re-use of otherwise redundant buildings in accessible locations will be more important than ever.
As Integrated Care Boards continue to produce infrastructure strategies for their respective geographical areas, an important factor will be to reflect on the potential role of the existing NHS and wider public sector estate but also private sector opportunities in delivering change locally. We can see scope for more partnership opportunities with landlords and landowners outside the sector, particularly those active in the town centre space, to support services being delivered where they are needed most. Nevertheless, making the best use of and driving the best value out of the existing estate should be paramount.
Our next and final piece in this ICS series will discuss how creating a ‘partnership of equals’ within and outside the NHS is at the heart of the ICS vision to ensure better outcomes for patients.