Comment / Moving beyond the buzz

It is hard to judge the potential of the health and social care devolution plan in Manchester – the so-called Devo Manc. What exactly it means, how it will operate and what it will enable that can’t be done
by existing organisations working in partnership – these are all difficult questions to answer. However, it is undeniably a good thing that the NHS is looking to pilot integrated care at scale.

‘Integration’ and ‘transformation’ are the new buzzwords of the modern NHS. Absolutely right too. Care co-ordinated around patient needs has to be what the health and social care sectors aim to achieve. And it is quite clear that the NHS cannot continue to deliver care using the same delivery models if it is to cope with the changing demography and a shifting burden of disease. The HFMA has itself been vocal about the need for such a change.

But the words themselves are in danger of becoming over-used. In the mouths of politicians and health service commentators, they have become the solution to all the service’s challenges. They may well be. But there is a world of difference between identifying the high-level response to financial and service pressures and actually grappling with the practical issues needed to realise those delivery models.

For some service lines, pathway redesign and optimisation is well under way. Our feature on health economies pursuing better integrated diabetes services provides a good example of exciting work – including plans for an outcomes-based contract in Liverpool.

But even in areas such as diabetes, where there is a good idea of the right pathway (through NICE guidance and standards), implementation is not straightforward, particularly in such tough financial times. Much redesign work requires upfront investment. Cost reduction through reduced hospital admissions, for example, may lag the service improvement by months or years.

There has been enough talk – it’s now time for action. So it is great news that Manchester will take forward its more co-ordinated city-wide plan. It is also good to see the vanguard sites working up local approaches to deliver new integrated primary and acute care systems and multi-specialty providers – key models identified in the Five-year forward view.

Similar themes run through these projects – in fact, two of the vanguard sites at Salford (PACS) and Stockport (MCP) are also part of the Devo Manc project. Risk stratification and population segmentation are key tools in the vanguard plans and this has to be the right approach as the service looks to be more proactive and shift the emphasis on to more integrated care and supporting self-management of long-term conditions wherever possible.

But as we enter this ‘doing’ phase, there needs to be an understanding and acceptance that not everything will work – or at least not everything will work in an optimum way.

We must also understand there may well be different models that suit different areas and diverse approaches to delivering the same overall goal of more integrated care.

There was apparently some surprise among vanguard bidders about the breadth of new models and approaches already being pursued. As we take the vanguard and broader integration models forward, we need to learn as we go, sharing successes and failures so others can build this into their own approaches. We can’t wait until we have a ‘perfect’ model at the end.

This will mean sharing models, governance arrangements, results and, importantly, payment and incentive mechanisms.

Finance professionals will have a huge part to play in all parts of the transformation process – from assessing new versus old model costs and value to getting the right payment models up and running to cover service costs and reinforce the right approaches to care.

And we need to use the finance network, through bodies such as the HFMA, to ensure this intelligence is spread as fast and wide as possible.