A bottom-up approach to health and social care integration

Health and social care integration is the current hot topic and comes with significant funding from government (£2.7b followed by 3100m in 2013/14 and then an extra £200m in 2014/15). If local authorities' use of personalisation implementation money in England is anything to go by - with the majority of the money being used to put resource allocation systems in place - then it is likely that most of the money allocated to support health and social care integration is likely to be used to fund top-down macro-structural change. Which may be missing the point...

We work to support very small community health and social care enterprises providing services to local people who need some support to live their lives. Successful services are co-designed with the people who use them and often span the boundaries between health and social care. People don't separate out their health and social care needs and so many community enterprises provide an integrated service. These local providers rarely fit into health and social care structures and pose significant challenges to bureaucratic systems. They thrive in areas where people have real control over their personal budget - and where local public sector bodies are prepared to make changes to their systems and structures to accommodate non-traditional provision.

Funky Fitness and Fun

Micro-provider Carita Smith set up her enterprise called Funky, Fitness and Fun in Oldham in 2008. She wanted to work with people with a disability or health problem and co-produce a different type of service. Carita is also a Shared Lives carer, a personal assistant and has co-run a drama group on a voluntary basis for adults with a learning disability.

The service currently runs two days each week at a local community centre. People become members and once engaged they are invited to share with Carita the type of physical exercise that they would like to engage in over forthcoming weeks. She then commissions it on their behalf and as a result Tai chi, dancing, aerobics, cheerleading and Elvis dancing, have all been included in the weekly sessions.

Michael has attended Carita's service from the outset and pays for it using his personal budget. Michael used to attend a traditional day service run by the Council. He did enjoy this but disliked the inconsistency of staffing and the inability of the service to always adapt what it provided to meet his needs and wishes. In contrast Michael is very positive about the service that Carita provides saying that 'Carita is her own boss and can do it'

Carita has also developed the "Funky Fitness Fun Team" which consists of four members with a learning disability who deliver fitness sessions to the wider community and in other service settings such as sheltered housing. Members feel valued by having this great opportunity and new links are being forged with the older residents.

Michael thinks Carita and the service that she offers is 'fantastic...it gives you a good feeling' He is trying to lose weight and hasn't exercised before but feels this is a great way to achieve his goal as 'it never gets boring'

This is all a preamble to an argument for a bottom-up approach to health and social care integration. We think that TLAP should continue its strong focus on enabling people with personal health and care needs to have personal budgets - and real control over the way that budget is spent. Making it Real has been a powerful tool and we believe should continue to change social care and be extended to our health colleagues. People live lives that are already integrated, they rarely see (and are usually baffled by) the silos and structures that seem insurmountable at a macro level. We know that people with real control make choices which challenge bureaucratic systems and structures. We think that a second focus should then be on ensuring that the very real challenges people face should be captured, overcome and the lessons learned aggregated in order to bring about the macro-system changes that are needed.


Posted on by Old Site User

I am 100% in agreement with this, and the project i am working on is all about understanding what needs to happen if the system is to change - the nuts and bolts and the philosophical arguments, the shift in perspective and the willingness of frontline staff to do things differently etc etc. The sort of initiative Sian describes is typical of how people make it work if they have the opportunity and the support they need - those of us who work to develop community-led projects know that the bottom up approach delivers the goods, and while i sometimes despair of anything changing at a 'macro-level', and suspect that those who operate at that level are immune to the idea they have anything to learn from non-professionals, in my heart i believe it is always 'the common people' (remember the song) who have the genius to know what is best for them, and how to get the most out of whatever resources are available to them. Integration may be the next big thing but experience tells us that large systems, with distinct cultures and hierarchical organisational structures are not pre-disposed to let go of the levers of power that they invariably possess and jealously guard for very good reasons (e.g. of self-preservation). We shall see how the Better Care Fund works, but meanwhile, all credit to the likes of Funky, Fitness and Fun for showing us the way!

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