We’re at the start of a radical integration programme, the first of its kind in the world, called Integrated Personal Commissioning (IPC).
The most radical part of IPC isn’t the integration of health and social care, or the entirely new financial incentives, or the central role of the voluntary sector. These elements of the programme are vital, but are being tried at scale in programmes around the world. The really radical part, the controversial part, the uncomfortable part, is to hand real power over to people and, if they choose to take it, to allow them spend their own budgets according to their needs and priorities – ‘what matters most’.
The publication of the Five Year Forward View signalled a resounding consensus on the need for greater integration of services. Vanguard sites implementing new models of care are being announced this week which will attempt to bridge three great divides: between mental and physical health services, between social care and health services, and between hospitals and primary care.
The IPC programme, as an integrated care model, will look to address these divides. But it is also attempting to bridge a fourth great divide. This is the often invisible divide between services and the people they were created to serve.
Many policy debates focus on service structures and manage to overlook the people who have the biggest interest in getting things right; the people and communities they serve. We fail to harness their energy, expertise and motivation at our peril.
Growing evidence shows that a failure to involve people in their care and treatment leads to far poorer outcomes and higher cost. Services themselves have a bias towards the status quo, even when the needs of the population change beyond recognition. And the population is changing – with dramatically rising numbers of people with multiple long-term conditions – so a very different health and care system is needed.
If we want to create a safe, sustainable and relevant 21st century health and care system, we will need to involve patients in their care and share power with them as equal partners.
So today we are announcing the names of the areas that will go forward as IPC demonstrators. They have a very hard task for the many thousands of people they serve, but a vital one. They are working to transform the lives of some of the most disadvantaged and intensive users of NHS and local authority services.
Different demonstrators are focusing on different groups, which include children with complex needs, mental health service users, people with complex learning disabilities and people with multiple long term conditions.
People in these groups will be supported to take a far greater role in their care, with increased peer and community support, and with the option of taking their annual budget for care and support as an integrated personal budget. Fortunately, there is strong evidence to say that, with the right support, people are surprisingly good at shaping their care. They are typically prudent and thoughtful commissioners, listening to professionals, and with a huge personal interest in getting things right.
But for me this is about much more than arguments about service quality and value for money. It’s also about a basic right to self-determination.
For many intensive health and care users, routine health and care services severely constrain how they live their lives.
I spoke to the mum of a young woman with complex disabilities about the care she was getting before she took up a personal health budget. She said that she was not prepared to accept an ingrained poverty of aspiration for her daughter just because she had very complex health needs, so she decided to write her daughter’s care plan and a detailed budget alongside.
She deliberately wrote the plan in her daughter’s voice, and, to give them credit, the health professionals were supportive and signed it off. The opening sentence in her daughter’s plan said “I am waiting for you to start my life”, because she says that up until now previously her daughter had not been able to live her life to the full. That has all changed now. Her daughter is confounding professionals and doing things they said could never be done.
As the IPC programme begins, we face some big challenges and we will certainly make mistakes. But we have a duty to raise our aspirations and try to make this work.
After all, there are many thousands of people waiting for us to start their lives.