Patients and service users must be part of the joint working jigsaw

Both of us are getting on. In a declaration of interest, we want to say there is no way we will see the next 20 years of our lives as a burden on either society or health and social care delivery in any way.

The fact that our generation is living so much longer than that of our parents is simply and unequivocally a good thing for us and for society.

‘The fact that services have become much more coordinated is a good thing’

OK, that good thing means that a whole range of organisations and institutions have to change, and that may mean a few problems. But that necessity, to create person centred coordinated care for these few million older people, is also a good thing.

So the fact that services have to become much more coordinated and person centred because of us and our cohorts is also (yes, you’ve got it) a good thing.  

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Coordinating care

The success that longevity represents does mean there will be more of us around with a mixture of physical health, mental health and care and support needs that do not line up with the separate funding silos and organisational boundaries that fragmented care has created.

Our generation will not only expect person centred coordinated care, but the greater amount of need will mean the fragmented services, which have in the past been so collectively wastefully organised, will have to be coordinated.

The better care fund task force is publishing a series of guides to help providers make the transition to person centred coordinated care; one of these will help local leaders understand, prepare for and engage in successful joint working to develop person centred coordinated care.

‘Fragmented services, which have in the past been so collectively wastefully organised, will have to be coordinated’

There is a remarkable consensus about goals. All three major political parties agree that in order to develop sustainable care we need to work together across systems and organisations.

Being part of such a historic development may sound a long way from the nuts and bolts of joint care, but such difficult changes will only be completed where there is:

• an accepted historic vision of the future;
• accepted immediate goals that cannot be achieved by individual structures and work units; and
• full engagement of all staff, from frontline to board level, with a clear recognition of the new behaviours required of everybody involved.

Again, there is a lot of agreement about the main facilitator of change and that is a compelling common narrative for national and local levels.

Personal narrative

All national system leaders, integration pioneers and many other local economies have adopted the narrative for person centred coordinated care coproduced by National Voices, the Think Local Act Personal consortium and partners.

The drive for these difficult changes can be found, not in the planning rooms of project management offices that organise the change – the reason exists in the lives of people who use health and care services, and their carers. They have become “experts by experience” when it comes to the problems created by existing fragmented care.

As it is vital that service user experience is brought into the rooms where this change is being developed, a personal narrative must be developed about how this work will transform the lives of service users and that narrative should be used in every meeting, every day.

To ensure we are working towards the outcomes that matter most to local people, and to get the redesign right first time, we must work jointly as partners, with the users of services.

‘A personal narrative must be developed about how this work will transform the lives of service users’

In the voluntary and community sector this is referred to as coproduction or co-design.

This is also recognised in the personalisation agenda developed in social care over the last decade as well as in the NHS Five Year Forward View, which says that engaging with patients and empowering communities are both “essential” to new models of care.

While the speedy establishment of the better care fund has allowed little time for local areas to coproduce their plans with their citizens, the development of real better care itself demands that staff start the “cycle of engagement” as soon as possible.

Joint working jigsaw

Patients and service users want coordinated care because it makes it much more likely that they will achieve the things they prize: independence, control and a meaningful quality of life.

Only they know how the care, support and treatment offered by statutory services will best achieve this.

‘Patients and service users must be part of the “joint working” jigsaw from end to end’

They must be part of the “joint working” jigsaw from end to end, and at every level from the frontline service to the senior strategy group.

Everyone agrees that what’s essential is trustworthy governance arrangements, along with clarity around joint decision making and accountability. This in turn needs to be buttressed by shared leadership at political and executive levels. 

The personal chemistry between local leaders is as important as formal plans and strategies. The importance of investing time in developing these relationships, to build trust and a better understanding of partners’ pressures and priorities, should not be overlooked.

The guides strongly argue that the soft stuff is actually the hard stuff.

Professor Paul David Corrigan CBE is former director of strategy and commissioning at the NHS London Strategic Health Authority, Richard Humphries is assistant director of policy at the King’s Fund.