He was reflecting on what I think is a step-change under way in the social care sector; the slow decline of combative relationships between commissioners and providers, and the emergence of a more collaborative culture across local systems. The Care Quality Commission recently published a fantastic report Building bridges, breaking barriers which describes the huge difference joint working can make to the lives of older people (also referred to in our own 2014 report) while recognising the progress still needed. It is clear that professionals have to work more closely together across divides of health and care, commissioner and provider, to understand the seemingly conflicting demands on organisations to do what is best for the people they support. The wellbeing of these people is ultimately the common goal.
Collaboration can be particularly difficult in social care. Intense financial pressures on both commissioners and providers over the past five years have stretched relationships to breaking point. The social care sector is fragmented; it does not have an identifiable brand like the NHS and it lacks the national and local infrastructure to drive a shared purpose. Providers can be reluctant to collaborate due to fears about staff poaching or losing a competitive edge in a period of radically reduced resources. This can mean care providers are side-lined, or only marginally consulted, when statutory organisations are responding to national initiatives.
However this ‘competitive’ behaviour is far from universal. Social care providers often collaborate in local forums, sharing good practice and working closely with commissioning teams. In some parts of the country, care homes are moving beyond a short-termism driven by fear of inspection and banding together to proactively improve quality. A great example of this is the Devon Care Kitemark, which provides the opportunity for care operators across the private and voluntary sector in Devon to exchange information and ideas, promoting best practice and supporting each other regardless of their status as ‘competitors’.
It’s essential that care providers are given the opportunity to engage with any local initiative to improve outcomes across health and care; where there is no established forum to engage with, statutory bodies should work proactively and in collaboration with local care providers to create one. This is especially important given the key role that providers play in the functioning of the wider health system. An example of this pivotal position is admission from care homes. Unnecessary A&E visits can put additional strain on hospitals, and unnecessary admissions can mean otherwise avoidable distress for residents. Care home residents aged over 75 are three times more likely to be admitted to hospital as an emergency than the rest of the population aged over 75.
We also know that care home residents can experience variable access to health services, often resulting in wider costs to the NHS. This has been recognised in the NHS five year forward view, and the Enhanced health in care homes vanguards are making important steps towards joining up health, care and rehabilitation services.
Here at The King’s Fund we are contributing to this vital area of improvement in partnership with long-established leaders in care home improvement My Home Life. We’ve set up a learning network for care homes to learn, develop and collaborate – with each other and with NHS and local authority commissioners – across six localities, with a view to building a more joined-up culture. We are currently in the process of seeking to recruit teams of stakeholders to discuss improvement in care homes and their role in wider systems improvement – and we’re keen to hear from those who are developing innovative partnerships.
In the fragmented social care system, NHS and local government commissioners along with providers across the statutory, voluntary and independent sectors should actively seek out opportunities to collaborate. This can be in the form of iterative contracting approaches, inclusive provider forums or collectively developed strategies and plans. But ultimately, it means prioritising the development of relational skills among leaders across the system, so they are able to work around short-term organisational issues and focus on their common cause.