Author: Lily Parsey

The recently published Integration and Innovation NHS White Paper has received very mixed feedback – from those praising it for front-lining a much-needed focus on integrating services, to those criticising it for taking away agency from local authorities and going back on previous commitments.

But what does it actually say (and what doesn’t it)? And what does it all mean for the prevention agenda?

At the end of February, as part of our Delivering prevention in an ageing world programme, we held an informal discussion webinar with key stakeholders from across the health and care space to take a deep-dive into some of these questions and explore what needs to happen next.

What the White Paper says (and what it doesn’t)

The “Integration and innovation: working together to improve health and social care for all” White Paper sets out three main priority areas:

• Firstly, to better integrate care systems by breaking down silos between different health, care and community settings – between different healthcare and allied professions and between the NHS and local government;
• Secondly, to harness the role of tech – and data in particular – to facilitate this integration;
• And finally, to provide more accountability by giving greater power to the Secretary of State to direct NHS England.

So, taking a look at integration

Across sectors, stakeholders have been calling for better integration of services within and beyond the healthcare system for decades. We know that the remit of health extends far beyond the health system itself – and that often the different actors involved in an individual’s health work in silos, resulting in fragmented care and a greater focus on cure than prevention and health promotion. In an ageing world, this needs to change.

Better integration is also vital if we think about democratising access to preventative health interventions, with many people most at-risk of developing health conditions only circling into the formal healthcare system at the point of treatment. Leveraging the vital role of trusted voices in the community, from more traditional settings like pharmacies to community organisations and care settings will be crucial in tackling deep-running inequalities in access, bringing together all actors that impact an individual’s health in a person-centred way.

The COVID-19 pandemic has acted as a catalyst to propel not only thinking, but real action in this area, highlighting first-hand that innovation is possible. The further roll-out of Integrated Care Systems (ICSs) as proposed in the White Paper was broadly welcomed by webinar participants, both as we build back from the pandemic, but also as we plan for a greater emphasis on prevention in the long-term in the context of an ageing society.

However, some of our webinar participants argued that integration needed to go even further. For one, there were concerns that despite its title “to improve health and social care for all”, the White Paper was still looking at quite a narrow definition of what “healthcare” entailed, with a very limited focus on the role of social care. And indeed, social care is often ignored in the health and care debate. Participants argued that, if the pandemic had shown anything, it was that social care “could no longer be a sticking plaster” or “an afterthought”, but needed to be properly integrated as a pillar of healthcare and the prevention agenda itself.

Secondly, there were concerns about the practicalities of integration – for example, how personal care could be integrated with community nursing, potentially offering a more holistic service, while also freeing up organisations like the voluntary sector to focus on preventative services.

So while the call for greater integration was welcomed, the message was clear that a commitment to integration needs to be followed up with real (and joint-up) action across sectors to deliver what it promises on the box.

Tech as an enabler for prevention – but not a silver bullet

The White Paper places a big emphasis on the role of technology in the future of the NHS. Our participants argued that it rightly points out the crucial role that tech (including the better interoperability of data) can play in integrating and joining up different actors involved in a person’s care, especially when it comes to leveraging the important work of professionals like pharmacists and nurses, or social care providers and community organisations. Following the experience of COVID-19, it’s clearer than ever that accessible and shared data needs to no longer be an aspiration, but a starting point to any meaningful cooperation between different healthcare professionals.

Technology can also play an important role in overcoming important barriers to access, whether that be telehealth services that remove distance barriers or integrated healthcare records that empower people to take charge of their own health.

But at the same time, technology in itself can of course be an important barrier. And our webinar participants reflected on how important it is to be conscious of the role tech can play – as a connector and enabler, not as a replacement for the people that drive and champion actual care.

The pandemic has been a catalyst of change and of real innovation. But where do we go from here? What is the future of face-to-face appointments? What innovation will stay, and what do we want to stay? In our discussions, it came through how important it will be to make these types of decisions not using a one-size-fits-all approach, but on a case-by-case basis.

The digital divide is still very real. Not just based on age, as often assumed, but often on socioeconomic factors, digital exclusion is preventing many from fully accessing the services they want and need. So while for some, a move back to face-to-face will be much needed, others, such as people who live with chronic pain, may welcome continued remote access even well after the pandemic is over.

So let’s take what we’ve learned from the pandemic, but let people decide what works best for them. While technology will undeniably be an important facet of the future of health, it will be vital to not lose sight of what it’s all really about: people.

Centralising responsibility for care – a step forward or backward for prevention?

The final proposal of the White Paper is a greater centralisation of responsibility for the NHS to make it “more accountable and responsive to the people that work in it and the people that use it”.

However, while brought in as a measure to clarify who is accountable for the health service, this proposal has received heavy criticism from a number of stakeholders as it risks undermining the day-to-day clinical and operational independence of the NHS.

Moreover, giving ministers the power to intervene earlier in local decisions about the opening and closing of NHS services could lead to the greater politicisation of local service decisions, sparking concerns about a potential growth of short-termism and political rather than outcomes-driven decisions focused on “quick wins” and treatment rather than prevention.

“We need to level up and bring regionalism into health, then you will have a prevention agenda”, argued one of our webinar participants.

And where does it all fit in the wider picture?

So now the question of where this fits into the wider picture…

While the White Paper sets out some important priorities, a number of our webinar participants voiced concerns that many of the important areas that should be included in a discussion on integration, such as social care, but also housing, education and infrastructure need to be brought into the mix to deliver real change.

Moreover, while mentioning the role of integrated care systems in the context of an ageing society, the White Paper makes no reference to the Government’s target to deliver an additional five extra years of healthy life expectancy for all by 2035. Similarly, there is no mention of the NHS Long Term Plan or other ongoing policy developments. So how exactly does this fit into the Government’s wider plans and can we expect to see the promised results?

It’s certainly a mixed bag. Many of our participants felt like the White Paper had been slipped in during the pandemic with not much plan for action or tie-in with existing strategies.

But focussing on what the Paper does do..

Alongside the catastrophic effects of COVID-19, the pandemic has nonetheless advanced opportunities for more tailored, more person-centred care. But to deliver on this vision, it’ll be vital to follow through on implementation and heed lessons from what we know works, and make sure that we’re tailoring services to those who are using them and need them most.

Technology has a great role to play in this, and better interoperability and availability of data will be integral to these proposals. Within this, we need to make sure it’s not tech for tech’s sake and that we make the most of its role as an enabler, without locking out people who are digitally excluded.

And to deliver prevention in an ageing world, it will be vital that greater Ministerial involvement doesn’t disempower local authorities and communities, leading to short-termism and political decisions that aren’t in line with the priorities set out in the Government’s Ageing Society Grand Challenge and NHS Long Term Plan.

As part of our Delivering prevention in an ageing world programme, ILC is looking beyond why we ought to promote prevention to how we can deliver it by:

• Democratising access to prevention to tackle growing health inequalities
• Inspiring and engaging policymakers, healthcare professionals and individuals with the prevention agenda
• Utilising technology effectively for prevention

We have published the three consultation papers gathering insights on what works in delivering prevention in an ageing world. Find out more about our programme and respond to our consultations here.