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Developing place-based partnerships: the foundation of effective integrated care systems: summary

Author:
CHARLES Anna
Publisher:
King's Fund
Publication year:
2021
Pagination:
8
Place of publication:
London

Integrated care systems (ICSs) now cover all areas of the country and will soon be established as statutory bodies with major responsibilities for NHS planning and funding. But most of the heavy lifting involved in integrating care and improving population health will happen more locally in the places where people live, work and access services, meaning place-based partnerships within ICSs will play a key role in driving forward change. These will need to involve a wide range of partners to act on the full range of factors that influence health and wellbeing. The King’s Fund reviewed existing evidence and experience on place-based working, explored the development of place-based partnerships within three systems and undertook targeted engagement with local leaders from ICSs, local authorities and voluntary and community sector organisations. This research highlights the potential role of place-based partnerships in improving health and wellbeing and illustrates how these opportunities can be realised. The successful development of place-based partnerships will largely rest on local implementation. The report sets out a series of principles to help guide local health and care leaders in these efforts. It explores how each principle can be applied and examples of how they are being put into practice. The report also explores the implications of these ways of working for the development of ICSs and for national bodies and regional teams as they approach the next stages of policy development and support for integrated care. (Edited publisher abstract)

Book Full text available online for free

Developing place-based partnerships: the foundation of effective integrated care systems

Authors:
CHARLES Anna, et al
Publisher:
King's Fund
Publication year:
2021
Pagination:
83
Place of publication:
London

This report seeks to understand how partnerships at the level of place (described here as place-based partnerships) are forming and to provide local health and care leaders with a set of principles to support their approach to working at place. In this report, we use the term ‘place’ to refer to the geographical level below an ICS at which most of the work to join up budgets, planning and service delivery for routine health and care services (particularly community-based services) will happen. Section 1 provides some context for this work by offering a brief overview of the relationship between place and public services, including relevant past initiatives, and outlining recent developments in national policy around ICSs and place. Section 2 then draws on insights from existing literature on place-based working, together with insights from our interviews and roundtable discussions, to explore how place-based partnerships can contribute to the improvement of health and wellbeing, setting out a number of core functions. Section 3 brings together insights from our interviews, roundtable discussions and the wider literature into a series of principles guiding the approach to building and developing place-based partnerships, exploring how each principle can be applied in practice. Finally, Section 4 looks across our findings to consider the implications for national policy. The report argues that as ICSs move on to a more formal footing, they should continue to focus on the priorities of their local places, ensuring that they are adequately represented in formal ICS structures and strengthening connections between priorities, governance and leaders at system and place levels. ICSs and place-based partnerships should prioritise the relational aspects of their development, with a sustained commitment from leaders to develop collaborative ways of working. (Edited publisher abstract)

Digital Media Full text available online for free

What is happening to life expectancy in England?

Author:
RALEIGH Veena
Publisher:
King's Fund
Publication year:
2021
Place of publication:
London

This article examines trends in life expectancy at birth up to 2020 and the impact of Covid-19 in 2020, gender differences, geographical inequalities, causes of the changing trends since 2011, and how the UK’s life expectancy compares with other countries. Mortality has declined since the 19th century, leading to a long-term rise in life expectancy for both males and female. Males born in 1841 could expect to live to only 40.2 years and females to 42.3 years, mainly because of high mortality rates in infancy and childhood. By 2019, life expectancy at birth in England had increased to 80 years for males and 83.7 years for females. However, the Covid-19 pandemic caused life expectancy in 2020 to fall for males to 78.7 years and for females to 82.7 years, the level of a decade ago. The data shows that people living in more affluent areas live significantly longer than people living in deprived areas. In 2017–19, males in the least deprived 10 per cent of areas in England could expect to live to 83.5 years, almost a decade longer than males in the 10 per cent most deprived areas (74.1 years). (Edited publisher abstract)

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Shaping the future of digital technology in health and social care

Authors:
MAGUIRE David, et al
Publisher:
King's Fund
Publication year:
2021
Pagination:
84
Place of publication:
London

This report sets out the findings of a review of high-quality evidence for how emerging technologies such as artificial intelligence (AI), smartphones, wearable devices and the internet of things are being used within care settings around the world, supported by a series of expert interviews. Although there is evidence that these tools have potential and can be used to support staff and patients with specific tasks (such as the use of AI in diagnostic testing or wearables in behaviour change), there are large gaps in the evidence base. More evidence is needed on a range of factors, including the cost-effectiveness of such tools, the groups best suited to using these interventions, the effects of digital inequalities on access, and the impact of tools that use digital technologies on outcomes. The public must also become a key stakeholder and partner with the health and social care sector while staff in the system and third-party suppliers need to be supported to improve implementation and design while building up the level of analytical skills throughout the health and care workforce. Local leaders need support to develop change management and analytical skills as well as how best to support to around how best to leverage the opportunities provided by digital technology to improve care for their populations. The report outlines three potential future scenarios for the health and care sector with regard to digital technology: a ‘techlash’ against new tools resulting from a loss of trust in how patient data is used; a continuation of the uneven spread of digital technology across the health and social care sector, with low-quality evidence stifling uptake of new tools; and a more optimistic view, where the support and quality of evidence we outline throughout this report develops within the sector and change happens at scale and speed. (Edited publisher abstract)

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The NHS’s role in tackling poverty: awareness, action and advocacy

Authors:
FENNEY Deborah, BUCK David
Publisher:
King's Fund
Publication year:
2021
Pagination:
51
Place of publication:
London

This discussion paper sets out findings from a process of engagement with stakeholders and wider literature and evidence, in particular: how more needs to be done to raise awareness of the NHS’s role in tackling poverty; what further actions the NHS can take; how the NHS can be a stronger advocate for poverty reduction; underpinning these three specific roles, the NHS has a partnership and leadership role that will help support them. The NHS is not powerless in the face of poverty. Much of what can be done is not about increasing the burden on an already stretched NHS, but being more aware of the existing power and influence the NHS has to tackle poverty. The paper finds that more focus is needed on the three As of awareness, action and advocacy: awareness of poverty and how this changes people’s needs and interactions with services; action in the design of care but also through the impact of the NHS as an economic and civic power; and advocacy for tacking poverty, given that the NHS and its staff have such powerful and influential positions in society. (Edited publisher abstract)

Digital Media Full text available online for free

The health and social care white paper explained

Author:
McKENNA Helen
Publisher:
King's Fund
Publication year:
2021
Place of publication:
London

This long read describes the main proposals of the Government’s white paper ‘Integration and innovation: working together to improve health and social care for all’, which sets out legislative proposals for a health and care Bill. The white paper groups the proposals under the following themes: working together and supporting integration; stripping out needless bureaucracy; enhancing public confidence and accountability; and additional proposals to support public health, social care, and quality and safety. The proposals represent a marked shift away from the focus on competition that underpinned the coalition government’s 2012 reforms, towards a new model of collaboration, partnership and integration. At the same time, removing some of the competition and procurement rules could give the NHS and its partners greater flexibility to deliver joined-up care to the increasing number of people who rely on multiple services. At the heart of the changes set out in this section is the proposal to establish integrated care systems (ICSs) as statutory bodies in all parts of England. ICSs will be made up of two parts – an ‘ICS NHS body’ and an ‘ICS health and care partnership’. The dual structure is a new development and recognises the two forms of integration that are needed to adopt a population health approach aimed at improving the health and wellbeing of local populations: integration within the NHS (between different NHS organisations) and integration between the NHS and local government (and wider partners). (Edited publisher abstract)

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Unequal Britain: attitudes to inequalities after Covid-19

Authors:
DUFFY Bobby, et al
Publisher:
King's Fund
Publication year:
2021
Pagination:
88
Place of publication:
London

Based on a nationally representative survey of over 2,000 people, this study presents a comprehensive examination of attitudes towards different types of inequality in the context of the coronavirus crisis. The study shows that the coronavirus crisis has not, as yet, unified the country on the need for a rethink on inequality or how to address it. Nonetheless, inequalities between more and less deprived areas (61 per cent), along with disparities in income and wealth (60 per cent), are seen as the most serious type of inequality in Britain. This indicates the strength of potential support for the government’s “levelling up” agenda – it very much fits with the public’s own priorities, almost regardless of background. But attitudes towards other forms of inequality, particularly between different racial or ethnic groups, are much more divided – inequalities between racial or ethnic groups are considered one of the most serious forms of inequality in Britain, after those between more and less deprived areas and disparities in income and wealth; but there is much greater variation in levels of concern between groups. Growing gender inequality following Covid-19 is a much lower concern. On top of significant variations in opinion, meritocratic and individualistic tendencies also temper calls for action on inequality. All of this means that while there is some appetite for change, it does not reach a level of support that unifies across political and demographic divides. (Edited publisher abstract)

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Written submission to NHS England and NHS Improvement: Integrated care: next steps to building strong and effective integrated care systems across England

Author:
KING'S FUND
Publisher:
King's Fund
Publication year:
2021
Pagination:
8
Place of publication:
London

This submission responds to the specific questions asked in the engagement exercise following the publication of Integrating care: next steps to building strong and effective integrated care systems across England (NHS England and NHS Improvement, 2020). This set out proposals on how systems and their constituent organisations will accelerate collaborative ways of working in future, establishing a new legislative framework for integrated care system (ICS). As well as focusing on the implications of the proposals for possible changes to legislation, the submission highlights areas where further detail or clarification is required. While welcoming the proposals, the submission highlights the lack of detail underpinning the legislative options; the potential disruption to the health and care system; and the limitations of what legislation can achieve. (Edited publisher abstract)

Book Full text available online for free

Evaluating the Care and Support Specialised Housing (CASSH) programme: results of a scoping exercise

Authors:
BOTTERY Simon, COOPER Emily
Publisher:
King's Fund
Publication year:
2020
Pagination:
29
Place of publication:
London

Findings of a scoping exercise to consider issues relating to a potential evaluation of the Care and Support Specialised Housing (CASSH) programme. CASSH is a Department of Health and Social Care programme to ‘support and accelerate the development of specialist affordable housing which meets the needs of older people and adults with disabilities or mental health problems’. We found it helpful to adopt a logic model which divided our work into two areas: policy and implementation. This approach might be appropriate for the evaluation. We found good evidence for the benefits of extra care housing for older people. This might not need to be repeated in a full evaluation, though it might consider a systematic review of the evidence and might want to explore evidence for other groups. We found significant difficulty with obtaining data about the operation of the CASSH programme and speaking to providers. An evaluation commissioned by DHSC would need to tackle both these issues, and DHSC might need to play an important role in ensuring data was available. Good engagement and buy-in from the implementation organisations would be important. The evaluation would also need an understanding of wider trends in the market of specialised housing for older and disabled people. Our research was limited by the small number of interviewees, which meant findings were not generalisable. A larger sample might be able to identify these generalisable learnings from individual provider’s experiences of the application and selection process. While there may be broad support among providers for improved data capture to aid evaluation, there will be a challenge to 'detangle' measurement of outcomes as result of people living in CASSH-funded housing, from the output of the capital funding itself. (Edited publisher abstract)

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Understanding clinical decision-making at the interface of the Mental Health Act (1983) and the Mental Capacity Act (2005)

Author:
GILBURT Helen
Publisher:
King's Fund
Publication year:
2021
Pagination:
48
Place of publication:
London

This report explores the context in which the decision of whether to use the MHA or the MCA to authorise a deprivation of liberty is made and the different factors that practitioners use to assess and weigh up which Act is most appropriate and ‘least restrictive’ for the individual concerned. The research used a mixed-methods approach with an online survey to capture the diversity of factors that influence decision-making across clinical groups, and qualitative interviews with clinicians and professionals to explore in depth their understanding of the interface and experiences of making this decision in practice. A large proportion of participants in this research report encountering people to whom this decision applies at least once a month, if not weekly. This decision most commonly applies to people who have dementia, but also to people with a wide range of mental disorders, including those with functional mental illnesses, neurodevelopment and neurological conditions. Participants report most commonly applying this decision to people in community settings, but application also occurs in mental health and acute hospitals including in the emergency department. There is a lack of common understanding around fundamental issues on which this decision is based including core concepts of capacity and objection. Blanket rules exist within professional groups and across different settings that restrict decision-making. The rights afforded to people admitted and treated in some settings and areas of England may not be afforded to those in others. The majority of participants report that their training covered decision-making at the interface of the Acts. However, codes of practice and case law are described as difficult to understand and keep up to date with. Understanding clinical decision-making at the in. Practitioners highlight a number of different ways in which patients are unlawfully deprived of their liberty as a result of the factors outlined above. (Edited publisher abstract)

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