Population-based health and care – devolution as a model for London
Over the past few months there has been a growing focus on population-based approaches to health and social care. The Kings Fund and others have published a number of documents on place-based care and accountable care organisations. We have also heard increasingly about devolution with the developments in Manchester and London, where five devolution pilots were announced in December 2015. The Five Year Forward View described the need to address the triple aim: improved health outcomes; quality of care; and cost. These aims, plus the recent advent of sustainability and transformation plans (STPs), signals a clear direction from NHS England – that plans should be delivered through a population-based approach.
UCLPartners hosted an event on 18 May 2016 to initiate discussion on how we can begin to do this in London. Over 120 healthcare leaders from across London were joined by representatives from national organisations at City Hall and, overlooking some of the icons of London such as the Gherkin and Tower Bridge, discussed how we can work better across health and social care to improve the health of our populations.
There were three main topics on the day: reviewing the evidence for change, introducing the London devolution pilots, and discussing how we overcome some of the barriers to enable such change. There was a lot of great discussion but, for me, there were two main themes:
1. We must view devolution as a process and an enabler for change – not the goal.
The STPs and devolution pilots give us the opportunity to do things differently – to really think about how we integrate services and develop more of a focus on prevention and wellbeing. It is vital to consider workforce and relationships to achieve this change. David Fish, our managing director, reminded us how key the workforce is to change. The national bodies represented at the event appeared to share the vision of the need for transformation. A recurring theme during the discussions was the need to focus and nurture relationships at all levels if we are going to achieve whole system change; one of the devolution pilots reminded us that the organisations all need to ‘hold hands and jump together’.
2. We must not lose sight of our ultimate goal – patient benefit.
Will Tuckley, chair of the London devolution board reminded us not to forget that this work is about the health and wellbeing of Londoners. Jeremy Taylor of National Voices also reminded us not get distracted by structure and reorganisation – but focus on what matters and what impacts on our patients. Patients are not interested in what transformation programmes we are engaged in – they just want good or better care. We should focus on doing the right thing for patients. For many patients it is often the little things that matter the most – the interactions that they have with the staff providing their care.
The event had a sense of anticipation and excitement – the opportunity for our health and social care system to really look at doing things differently to improve care and outcomes for our patients, whilst also addressing the financial deficit. Personally, I am excited to see what the next few months bring as the STPS and devolution pilots continue to develop. I hope that our health and social care leaders retain the optimism expressed at this event and the desire to think creatively and push boundaries, whilst always keeping at the forefront what matters and impacts most on the health of our population.