Big Society public services - health & social care: patients in control
On 21 July, as part of our Big Society Public Services series, the Institute for Government, NESTA and the Design Council hosted a seminar on the future of health and social care in light of the Big Society agenda. This page contains an overview of the discussion.
The panel
- Dame Jo Williams (Chair, Care Quality Commission)
- Dr David Lyon (GP, Castlefields)
- Prof Gwyn Bevan (LSE)
- Prof Tony Hazell (Chair, Nursing & Midwifery Council)
There is a case for the Big Society
The point was raised that a Quality Adjusted Life Year (QUALY) - i.e. a year of good wellbeing - is affected by more than just healthcare. Factors such as a person’s psychological and social condition can also have a massive impact on a person’s wellbeing.
The community has a potentially significant role to play in supporting wellbeing. Evidence suggests proactively managing long-term conditions in the community - rather than waiting until the next chronic episode and being admitted into acute care - can have significant health benefits and is much less resource intensive.
The panel's preferred option was to avoid institutionalisation. Acute care can quickly turn people into patients. The consensus was that community groups have a lot to offer.
The trick therefore that the Big Society agenda needs to pull off is to unlock the potential for good quality relationships and social networks in the community.
Services need to become more 'people centred' and focus on developing social capital in an area.
The panel was aware that utilising a locality's available resources may mean services are wrapped around public needs differently in different areas.
The case is supported by existing examples
The panel were positive about the potential to unlock social capital in an area, given there are already numerous examples to draw upon.
Often integrating community support with traditional health services requires a focal point to coordinate actions.
The 'Unique Care' model proves an example of how integration can occur. The model co-locates health, social services and community groups.
This allows the joint assessment of need, awareness of the resources available in the local area to support the person’s individual need and allocation of resources in accordance with need.
Other examples raised included cancer charity Tenovus' Mobile Cancer Support Unit Bus. This works in partnership with Velindre NHS Trust and has been delivering chemotherapy in the heart of the Cwmbran community for the last five months.
Obstacles to the Big Society in health and social care
Funding streams
'People and patient-centred care' can mean a number of things and the differences need to be made apparent.
It may mean tailoring and designing services to meet the needs of patients. Alternatively, it may mean giving patients control over their own budgets so that they can buy the care that they need.
The previous Government piloted individual budgets and direct payments for care as part of its Putting People First initiative, which aimed to personalise of adult social care services.
There may be a tension between giving budgets to both GPs for health care and to patients for social care. This could be overcome if professionals sit down with patients, and together they make the right decision.
BackThe Big Society needs...
Distributed leadership
Professional groups are already heavily involved in neighbourhood work. For example, 22,000 nurses already work in community care settings.
Nevertheless, the Big Society requires 'distributed leadership' to harness community action. This is needed where leadership does not come from a particular professional group, but through consultation between professionals and community leaders.
In areas with low social capital, further professional training is required so professionals know how to develop leadership capacity within the neighbourhood.
A different attitude to risk
There needs to be debate about responsibility for risk. At the moment there is pressure on professionals to mitigate risk as much as possible. This is because they feel they are personally liable in all instances.
This can stifle innovation and the involvement of non-state groups in the provision of care. In addition, the health system responsible for risk de-motivates and deskills people who try and manage their own health conditions.
Currently, there is professional fear of encouraging individual, family and community groups to take on more responsibility.
Health professionals will need to accept the population's greater role in their own healthcare and more responsibility for their own health needs. A debate is therefore needed with professionals as to whether they will accept a higher degree of risk.
A comment was made that at the moment there is a lot of dependence on health professionals and institutions to take on responsibility for health needs.
A debate about whether the public is willing to accept social responsibility rather than state control as the driver of social progress - and the role individuals can play in driving social responsibility - also needs to occur.
A changing role for inspection
A role of inspection in the Big Society will be to address societal power imbalances.
In an ideal world, data on health and social care would be fully transparent and communities could interpret the data and make fully informed decisions about services.
However, in reality many people do not have access to information and need support interpreting it. Inspectorates will need to address these power imbalances as best as possible.
In addition, inspectorates will have an increasing role in determining whether local services are accountable to local preferences. This may mean they re-devolved into the community so that community needs are fully understood. These 'experts by experience' will have a role in challenging providers to provide what matters most locally.
In future, the relationship between inspectors and communities may become more fluid. Complaints from the community matter - families and friends will have responsibility to raise concerns, challenge, and bring about change in the system.
The value of community care represented in the decision-making process
It is hard to quantify the benefit of family and community care. This makes it difficult to account for the value community organisations can provide in the commissioning process. In addition, the traditional output commissioning process prevents a lot of the social capital in a community from being harnessed.
Prof Gwyn Bevan presented a social process through which resources can be prioritised. It takes the public and professionals through a process whereby the greater value for money offered by early interventions and care in the community - in contrast to acute care - can be easily visualised.
This allows status quo resource allocation decisions to be challenged in a way the public and professionals can agree upon, with the potential for funding to be reallocated towards the community.
