Transforming Your Care and the third sector
Transforming Your Care was published six years ago. So far, not a lot has been transformed.
The bulk of the changes envisaged under the seminal report on Health and Social Care were due to have been completed by now. This is not the case.
However, some of the reforms – or, at least, the bedrock of future reforms - are in place, and there is an opportunity for ingenuity to solve an increasing amount of problems on a local level. Here the third sector has a role to play, a role that could be massive.
Scope has written at length about some of the barriers that have prevented the changes – including a lack of political bravery and also clear communication with the public of the reasons why reform is necessary.
However, these are not the only problems. The high-level aims of TYC – and Donaldson, and Bengoa, and now Health and Wellbeing 2026 – are extremely ambitious, involve changes that are both deep and broad, and would represent a challenge for an organisation of any scale, let alone something as enormous as the health service.
Another stumbling block is finances. This week the Northern Ireland Audit Office published a report into the progress of TYC, or lack of it, which detailed some of the good work that has taken place – as well as significant shortfalls.
One of the most striking aspects of the report is that the estimated gross costs of TYC reforms are £148m, yet only £40m has been spent so far – an £108m shortfall – while £130m in benefits were expected to have been realised so far, yet only £28m has actually been released, meaning an additional £102m could have been saved.
Surely £6m could have been found from somewhere and, thereafter, it pays for itself (based on the estimates which, to be frank, are necessarily imprecise)?
There are two problems with this that, in combination, represent the real difficultly. Firstly, savings like this always come after the spending, not at the same time – even if the timescale to make these savings is short, in the general context.
Secondly, the reason why reform is happening in the first place is pressure on services.
An ageing population leading to more people living with chronic conditions means provision is stretched to breaking point and that demand is set to outstrip any possible growth for the years and decades to come, under the current model.
This means reconfiguration is necessary but that finding the money to make it happen is difficult. If frontline services are creaking, where do you free up funds? Per the report:
“TYC has faced considerable difficulty in releasing funding from the acute sector to increase investment in primary and community care as a result of the growing demand on existing services. While there is considerable potential to release finance already in the health and social care system… To date, TYC has not received dedicated funding to support the change agenda and this has undoubtedly hampered the reform process…
“Providing ring-fenced financial support for the transformation of health and social care services is currently exceptionally challenging. However, funding transformation represents a significant investment in the future of health and social care services and the alternative is to risk a decline in the quality and safety of that care and a reduction in access to, or the breadth of, services that HSC Trusts provide. Without resources specifically dedicated to transformation, there is a risk that health and social care services will be unable to deliver the changes considered essential by TYC and that the costs of continuing to provide services along traditional lines will only get larger.
“Towards this end, we acknowledge the creation of a ring-fenced £30 million Health and Social Care Transformation Fund for 2016-17. Its specific purpose was to fund innovative projects aimed at improving outcomes for patients and also saving money that could be redirected to other frontline services. Funding such as this can be a catalyst for change, however, we are aware too of the risk that the Fund may become subject to pressure to fix immediate crises, support pet projects or, potentially, be an easy target for expropriation when extra funding is needed elsewhere. It will be essential that some level of guarantee can be given to prevent funding being diverted away from the purposes intended.”
Ingenuity and the third sector
Perhaps the central idea of TYC is the shift of services away from (expensive) acute settings (which are also curative rather than preventative in nature) and into the community and, where possible, the home.
Built into the strategy for TYC – and its descendants, including Health and Wellbeing 2026 – is further room for tailored solutions on a community basis, and for good ideas that deal with specific problems. This has always been a strength of social enterprises and NI organisations should see this as an opportunity to grow, by offering services that suit local people.
Integrated Care Partnerships (ICPs) are a key part of health reform. Per the Audit Office report:
“At the heart of TYC was the establishment of 17 Integrated Care Partnerships (ICPs), each covering a population of around 100,000 people. ICPs are collaborative networks of care providers whose priority is to make sure each person gets the care they need, in the right place, at the right time…
“By March 2016 all 17 ICPs had been fully populated, each comprising 13 members: one medical specialist; one nurse; one allied health professional; one social worker; one member of the ambulance service; one member from the voluntary sector; one from the community sector; two service users/carer representatives; two GPs; a council officer concerned with community planning and two community pharmacists.”
The establishment of ICPs has been one partial success story of TYC thus far. They are able to tailor care pathways – and have done so for some areas already. However, there is much more to be done,
One of the main criticisms the Audit Office has levelled at TYC has been, alongside an absence of dedicated funding and a reliance on monitoring rounds to fund necessary change, is the lack of detailed action plans.
This problem emerges both from the funding difficulties outlines above and also from the political machinations Scope has outlined before – action plans are specific, and the specifics of TYC will see some winners and losers.
But focusing on hospital rationalisations, for example, is focus on the negatives and, if TYC is to be successful, there will be plenty of success stories to be told.
If third sector organisations (or anyone else) are able to identify specific solutions to health problems they should not be shy about contacting ICPs to offer up their ideas – especially with a lack of detailed planning implying a vacuum in future specifics generally.
The ICPs’ establishment, and shift away from centralised planning, allows for these solutions to be local, rather than just NI-wide (though of course these will be welcome), providing more flexibility in what can be achieved.
These are difficult times for health and social care but there are opportunities for good ideas to prove transformative in communities across Northern Ireland.
Join the Conversation...
We'd love to know your thoughts on this article.
Join us on Twitter and join the conversation today.
Join Our Newsletter
Get the latest edition of ScopeNI delivered to your inbox.