Reform of NHS England: Innovation Unit’s view

news | Words Sarah Gillinson | 11 Feb 2021

In response to the news that the government is planning to reverse reforms of the NHS in England, Sarah Gillinson, chief executive of Innovation Unit says more should be done to achieve greater integration and innovation.

Innovation Unit offers a cautious welcome to the draft version of the government’s White Paper on Health, Integration and Innovation: Working together to improve health and social care for all.

The government correctly identifies that collaborative working and innovation can combine to improve outcomes for local communities, individuals and the nation more broadly.

Work by Innovation Unit to help the UK health and social care systems adapt and evolve so they can address the complex challenges facing them has shown that it is possible to improve, integrate and innovate – at scale.

Reflecting the ambition of the White Paper, we have a strong track record of bringing together different organisations and layers of the health system to develop shared vision, make collective decisions, solve shared problems and decide on the effective use of resources. This place-based transformation of public services cuts across service and sector boundaries to create much better outcomes for the people using them.

That said, changing structures and asking people to collaborate more is nowhere near enough to achieve greater integration and innovation. Time, resources, facilitation, action learning and more system leaders are some of the things that will be required to bring this vision to life.

Structural change is easy to achieve. Major shifts in culture, practice and leadership are much harder – and these must be the focus if the goals of integration and innovation are to be realised over time.

How IU can help the NHS integrate and innovate

We grow and scale the boldest and best innovations that deliver long-term impact for people, address persistent inequalities, and transform the systems that surround them. We do this in a number of ways:

  • Convening: We bring people together to have difficult conversations, helping diverse groups with different interests to find a common way forward, without flinching from the hard stuff
  • Connecting: We link systems up from top to bottom and side to side, so that different plays can actually hear each other, begin to understand each other’s perspectives, build relationships and collective action.
  • Learning: We generate insight from action while it is happening and use this to help our partners adapt their work and keep heading in the right direction.
  • Grounding: We enable those people with lived experience to have a voice, not just through participative research but by producing materials that bring these experiences to life and encouraging diverse coalitions to consider the implications.
  • Enabling: We have tools and processes to build the capacity of organisations and local communities to do this work for themselves.

Examples of innovation and integration in practice

We help local systems to improve outcomes and reduce inequality by designing and delivering innovation programmes that develop, test and evaluate new ideas, and then spread and scale those ideas; we then help others adopt and adapt innovations that have been successful elsewhere; and we play the role of learning partner that helps share knowledge and experiences between innovators and adopters.

Health care and coronavirus: radical change in Greater Manchester during the pandemic

As the White Paper outlines, Coronavirus has placed all aspects of the health and social system under intense pressure. Our work across Greater Manchester during the pandemic shows that meaningful cooperation, collaboration and collegiality are possible, even when the world as you know it is coming to an end.

In March 2020, as the UK went into lockdown, providers of public services, charities, businesses and others began to offer their talents, ideas, energy and resources to help protect communities in Greater Manchester.

Determined to capture and learn from these experiences, teams from across the Greater Manchester Combined Authority partnered with Innovation Unit to codesign and co-facilitate a rapid analysis of the effects and implications of innovations introduced across the city region.

The result was a more unified and improved system of public services, a bank of knowledge and expertise that could improve outcomes elsewhere across Greater Manchester, and confidence that the Authority could be much more radical in pursuing its future ambitions.

My care, my way: refining a proactive and holistic care model for over-65s

The traditional, clinical model of care is reaching its limits, with services for older people too often disjointed and unable to meet people’s needs in a holistic way. Within the health and care system we need to radically reorganise care to help more older people stay healthier for longer.

Innovation Unit worked with West London CCG and PPL to refine and develop a new integrated model of care for older people. This model is underpinned by an innovative service called My Care, My Way.

This holistic system is built around four core elements: two patient-facing roles based in GP practices; multidisciplinary assessments and extended appointments; the provision of social prescribing that allows patients to manage their own health and wellbeing; and a whole system approach that enables the identification and support of less complex patients who might be at risk of slipping into poor health.

Scaling and spreading innovation in children’s social care with No Wrong Door

The effects caused by pressures in funding and wider resources on the system can mean that young people who are in care or on the edge of care can feel as though they are being bounced between services and residential or foster placements.

It’s not uncommon, for example, for young people to be sent to ‘out of area’ placements far from their friends and family. This can be damaging to their mental health and wellbeing and subsequently very poor outcomes in later life.

No Wrong Door is an integrated and innovative approach which provides reliable, caring and effective support to young people facing risks in their care. The model combines residential children’s homes specialist fostering, high needs supported lodgings and bespoke placements with an outreach offer to young people living with their families. At the heart of the model is a hub based in a children’s home, which provides short-term residential placements and outreach support to 30-40 young people at any one time.

Independent evaluation of No Wrong Door shows that it creates significant financial savings, improved outcomes for young people and reductions in the numbers of children looked after, including a 92% reduction in hospital admissions – demonstrating the impact across the entire health and social care system.