A case study of a council and place that scores higher in this aspect
Our place has a highly integrated health and care system, with shared organisational leadership. We have mapped out need across the area and have a simple system of identifying five levels of need. Most of our work is structured around localities, which are engaged with the community, voluntary, and faith sectors, partly thanks to our very ambitious investment programme in that space. We have not quite got the balance of in-house and contracted provision right yet, as we still have some fairly inflexible whole-place provider contracts and some are struggling, but we are planning to bundle this differently the next time we procure, to connect better to localities.
We are experimenting in a few localities with self-organising social care and district nursing teams, and in one with dementia-friendly places. In others, where there are problems with the night-time economy, mental health, and hospital admissions, on working closely with the police, particularly at ‘hot spot’ times, we also have a key-worker service for people with very high levels of ambulance and A&E utilisation.
Ward councillors, advice services, and community groups play a role in steering locality decisions and signposting need. We are starting to engage deeply with carers and service users and have plans to bring them in to locality governance. As we had identified mental health issues and physical health as priority areas for intervention and prevention, we are working on locality-based strategies for green spaces and fitness offers, as well as seeking innovative ideas around counselling services.
A case study of a council and place that scores lower in this aspect
We are trying to join up locally through sharing data and planning, but outside of the formal governance structures, this does not fully carry through. There was a legal dispute between the council and clinical commissioning group about continuing healthcare funding several years ago, which resulted in some historic “bad blood” and a lack of trust. The data, at least, is useful, though we do not think it is completely accurate, as we are a ‘green and leafy’ place where we see an outflow of younger families and professionals and an inflow of retirees. Though the retirees are often relatively wealthy, increased costs of living can really bite.
We are struggling with high demand for vulnerable adult services including dementia, so that is taking up a lot of our time and attention and we are seeking more funding and to create early intervention and prevention services. We are not getting much of a response from the market on innovation and new opportunities and increased funding, even though they complained when we did a care cost and quality exercise that our focus on driving down costs was holding them back from offering us new ideas and options.
We have worked with housing associations to handle access to our limited residential care but are worried about the implications of future Care Act changes. We are beginning the journey of multi-disciplinary teams in a few locations, but there is real concern about how it will impact on social worker caseloads and time with clients, particularly as some of our clients are relatively isolated and travel times are lengthy. A major concern is the increasing number of residential care planning applications being approved, which will inevitably increase our demands and costs.
Equality and equity considerations with this aspect
Whole system design is likely to highlight issues of inequality and inequity in conditions and access to services. Care should be taken to include marginalised voices in governance, leadership, and delivery, and to resist picking ‘quick wins’ which may further exclude marginalised and under-served groups.