Skip to main content

Shifting the centre of gravity

Making place-based, person-centred health and care a reality

In 2016, the Association of Directors of Adult Social Services (ADASS), the Local Government Association (LGA), NHS Clinical Commissioners and the NHS Confederation published ‘Stepping up to the place’. This set out our shared vision for transforming health, care and wellbeing and the key actions that national and local organisations should take to successfully integrate health and care.

Now, in 2018, joined by NHS Providers and the Association of Directors of Public Health (ADPH), we have refreshed our vision and action priorities to make sure they remain relevant for the next phase of transformation. The refreshed vision is based on a wide-ranging review, including a study of progress since ‘Stepping up to the place’ and the implications for our original vision, commissioned from the Institute of Public Care (IPC) at Oxford Brookes University. This included case studies on six localities – Croydon, Dorset, North East Lincolnshire, Nottinghamshire, Plymouth and Rotherham – and an evidence review of good practice which includes many case examples.

The review also draws on recent reports on integrating health and social care from national bodies; learning from a wide range of case studies showing good practice in implementing integrated health and care; and the ongoing experiences of our members in planning and delivering integrated health and care in the context of very real operational pressures, which were fed into the review through the steering group for the refreshed vision.

Overall, the review found many excellent examples of how partners are making real progress in improving outcomes for individuals and populations, so that people are healthier and more able to lead independent and fulfilled lives. We recognise too that progress on integration continues apace in many areas, not least Greater Manchester, where arguably they are furthest advanced in adopting a strategic placebased and person-centred approach aimed at maximising health and wellbeing. A selection of examples is included in section four of this report.

The review also found that the biggest challenges for organisations working on integration were the severe financial pressures facing every part of the health, care and wellbeing system. This has meant that sometimes the focus has shifted from long-term, sustainable transformation to firefighting the results of insufficient funding and rising demand. ‘Shifting the centre of gravity’ describes the shifts that need to be made so that partners can remain on track to achieve the benefits of integration.

At the time of writing, there is a new fiveyear financial settlement for the NHS, and an NHS long-term plan is being developed alongside the much-delayed Green Paper on adult social care. These documents will set out the direction for health and care in the coming years. Integration and prevention are expected to be key elements of the NHS long-term plan and, as partners working with NHS England and NHS Improvement to develop the plan, we have used emerging information to shape this report. As yet, there is no long-term funding settlement for adult social care. We are agreed that without a sustainable settlement, the ability of organisations to deliver the full benefits of transformation will be in doubt.