From Total Place to devolution deals, there have been numerous efforts to encourage public services to work together to solve problems in local areas - the places where people live. In the health sector, too, there has been talk for some time about place-based health, but this didn't immediately take off.
Yet the Five Year Forward View - the blueprint for health reform - really gave this concept new life when it called place-based sustainability and transformation plans (STP), to be built around the needs of local populations and focusing on prevention.
Place-based health success
As a result of this drive, a fast-changing provider landscape is emerging in communities. Instead of traditional general hospitals and GP practices, place-focused integrated care hubs, locality teams, and neighbourhood care teams are springing up everywhere.
While so far this vision may be health-dominated, its enthusiasts are clear that social care needs to be at the heart of a place-based care system. But social care, hit with cuts over recent years, continues to have to disinvest in some of the facilities that tie it to local places, such as day-care centres. And without money to invest in new models of care, new forms of local services have often been difficult to create.
So what would be in a local placed-based social care and support system? Here are eight things you would expect:
- A commitment from systems leaders across statutory and community organisations to pool resources and develop long-term plans for place-based, integrated, and preventative health and social care
- Services co-produced by people from the local community so they reflect local priorities and needs
- Services designed to harness local community assets - people's skills, capabilities and networks, rather than being focused on their problems
- Care homes that extend local services into communities and welcome people in
- Neighbourhood co-located health, social care and community hubs where people can access services and make connections
- A care system that measures success in terms of improved wellbeing, independence and social connectivity, not just via savings to hospitals
- A commitment to keep people, who have complex support requirements, living near home or in home, using models like Shared Lives
- Community navigators, who work with local people to help them find and use local resources, e.g. peer support groups or dementia friend groups.
In some places, pleasingly, some of the above is already beginning to happen. In Leeds for instance, neighbourhood teams comprising health and social care staff have been established to make sure people have the right support at the right time in the right place by the right person. In Wakefield, York and Cornwall, they’re trying something similar. But progress towards place-based approaches is slow.
Challenges ahead
One thing that has often limited the space for developing more innovative power-sharing approaches is the essential focus by organisations on reducing their own costs and maintaining local confidence. New place-based models of care, co-designed with local people, also take time and money to build. So it's tough.
If the history of developing place-based approaches tells us anything, it is that people always want their services close to home, in the places they live and know best. Social care can still be at the forefront of a more place-based approach.
Ewan King is director of business development and delivery at the Social Care Institute for Excellence (SCIE)
