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The journey to place based health

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PHE Chief Executive Duncan Selbie and Henry Kippin, Executive Director of Collaborate CIC, welcome the findings of the Commission on Place Based Health, published today.

The stage has been set for a significant shift towards place-based health across the health service.

The NHS Five Year Forward View set the tone with an explicit focus on new models for population health management.

In November last year the Kings Fund published its call for ‘place-based systems of care’ as a basis for long term policy.

And recently-issued NHS planning guidance for local health and care systems, who will now be required to develop place-based–Sustainability and Transformation Plans (STPs), translates this concept for future services into a requirement in practice.

Into this fertile space lands the Commission on Place Based Health – a 15-strong commission chaired by Lord Victor Adebowale tasked with exploring the concept and offering some practical guidance on how to make it happen.

In its final report, published today, the Commission argues that a focus on ‘place’ not only reflects the emerging direction of travel for the NHS and local government, but that it represents the best hope for achieving a sustainable health system for the future.

A simple proposition lies at the heart of place-based care: that we blur institutional boundaries across a location to provide integrated care for individuals, families and communities.

Energy, money and power shifts from institutions to citizens and communities.  Devolution becomes an enabler for a reform programme that starts to deliver on the long-held promise of joining up health and social care for a population in a place, with the ultimate aim to improve the public’s health and reduce health inequalities.

There is no way that a truly joined-up agenda for health and care can stop at the boundaries of NHS-funded and social care-commissioned services.

If we want to build human capability and aspiration rather than perpetually meeting need as it presents itself, we need an approach that is collectively accountable to outcomes that reflect this.  The Commission has mapped out a route to develop such an approach, but it will depend on some vital enablers being in place:

1. Busting through the evidence paradox
Building a credible investment case for prevention is critical. It is the flip side of recent calls for a cross-party consensus on sustainable funding, and vital to the fostering of confidence and trust between health and care partners.

The operational pressures that NHS agencies are working under means they are often reluctant to invest in prevention due to a lack of clear evidence that prevention activity saves money. That is why Public Health England and the Chartered Institute for Public Finance and Accountancy have committed to creating a set of professional standards for creating place-based business cases for investment in prevention and early intervention.

2. Sustaining focus on integrated local services
Commissioning integrated services has often failed to gain traction because two functions have been underplayed: ‘system translators’ – individuals who can bridge the divide between health and local government to build trust and coordinate and galvanise action, such as a councillor who has been a GP, or someone in a clinical commissioning group for example; and ‘commitment devices’ – a range of methods to hold systems to account on the basis of outcomes, such as holding regular meetings, setting joint objectives or pooling budgets.

Recognising and investing in these functions is an essential ingredient of place-based health, as the Commission shows in its case studies.

3. A deliberate focus on readiness for change
We need to be more deliberate about building transformation readiness across the health and care system, including investing in joint workforce planning, ‘place-based’ outcome agreements, ‘place based financing’ – with a focus on maximising outcomes from the ‘local pound’ and collaborative frameworks that hold a range of local organisations to account.

The foundation of this should be much better and more consistently used insight into communities and the aspirations and assets of local people.

The work of the commission is very closely aligned with PHE’s work to improve health and reduce inequalities.  Since its inception PHE has actively championed the relentless focus that local government has on people and place, and remains at the heart of supporting the healthcare system to make this paradigm shift.

This shift is starting, but there is much more to do and the Commission on Place Based Health provides yet more evidence and a clear route map to progress further and at pace.

The final report of the Commission on Place Based Health is published today by Collaborate CIC and the New Local Government Network.

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