Welcome intentions for a duty to collaborate, but our people need to see the benefits & rationale for change to embrace it

A government White Paper, published by the Department of Health and Social Care (DHSC) on 11 February 2021, sets out new proposals for health and care reform. The blueprint makes a decisive step away from the focus on competition, towards collaboration, partnership, and integration between the two services.

‘Integration and Innovation: working together to improve health and social care for all’ builds on the NHS Five Year Forward View, the NHS Long Term Plan, and looks to further the flexibility our NHS workforce and organisations have shown throughout the pandemic. Clarifying its definition of health and care as: “everyone who works tirelessly to deliver high-quality care and support to people all over the country, including NHS organisations, local authorities, voluntary partners and charities”, the proposals aim to modernise the legal framework, remove unnecessary legislative bureaucracy, and bring our public health, social care, and health services closer together to transform care and tackle health inequalities.

Over recent years, our involvement in the development of Integrated Care Systems at a local level has clearly demonstrated the vital importance of collaboration and partnership, and in the last twelve months we have seen this accelerated, becoming a defining feature of the COVID-19 response. Many of the measures outlined in the paper are a welcome and much needed step towards formally embedding this into how our NHS operates in the future, by providing the necessary updates to legislation to make this happen. However, we know from experience, that legal structures are only part of the answer to ensuring our health and care systems can deliver higher quality care in a way that is more joined up locally.

The white paper rightly acknowledges that a new legal framework is a necessary but not a sufficient condition for integration and improvement: “legislation can help to create the right conditions, but it will be the hard work of the workforce and partners in local places and systems up and down the country that will make the real difference.”  Though a better governance platform will help, the changes in cultural mindset, behaviour, experience, and leadership, are what is required to enable our health and social care workforce in its entirety to achieve the ambitions outlined in the DHSC’s proposals.

The timing of the paper has been questioned in a number of quarters. However, in a positive light, it can be seen as an endorsement of the efforts already being made. Better integration of health and social care is what leaders across the NHS want to see acknowledged. Yet it must be recognised that the move away from organisational silos to collaboration, and delivering more user-centred, personalised approaches to care, remains a huge challenge.

The paper states the proposals will be supported by an implementation programme that “recognises the importance of key non-legislative enablers in facilitating change.” Through our experience in working to support the integration of health and social care, we know that the changes required are highly complex, and this is emotive work that ultimately leads to difficult choices being made. A duty to collaborate is very well meaning in intent, yet we know that in human systems, it is people who will make their own choices of how to work together. It is vital then, that the workforce is able to see the benefits and own the rationale for change at a local system level.

Similarly, structural changes must be clearly linked to a shift to focus on outcomes for the end service user. Putting citizens, patients, and services users at the heart of our health and care systems is crucial for reform. Changing plaques on doors, or titles on email signatures, does not equal change. As we have seen over the last twelve months, the collaborative provision of services is achievable, but we know that sustaining reactive change is difficult.

The Government’s implementation programme must address the human experience of change, and acknowledge the challenges of systemic, over-organisational service delivery. There is no doubt that this is change that people will agree is worthwhile and support. However, making this a reality, rather than simply something that is ‘good on paper’, will take significant work and effective change management to achieve a real culture shift across our health and social care services.