Integrated health and social care has featured in policies across England for the past two decades (Wilson et al, 2015). This is because joined-up services have and continue to be viewed as the primary way to simultaneously reduce duplication, improve service outcomes and achieve fiscal savings (Wilson et al, 2015; Naylor et al, 2016). This is particularly pertinent in the current policy environment, with the NHS and social care system under increasing strain to meet financial and performance-related targets (Alderwick et al, 2016).
In the past three years, the movement toward integrated health and social care has evolved significantly. In 2014, arms-length bodies for the NHS published the Five Year Forward View (NHS, 2014). This outlines three core challenges for the NHS;
- The health and wellbeing gap
- The care and quality gap
- The funding and efficiency gap
The Five Year Forward View (FYFV) covers the period between 2016 and 2021. It aims to deliver new ways of working to meet the challenges outlined above and provide better outcomes for service users and communities (NHS Confederation, 2016). Following publication of the FYFV, NHS England and national partners launched the New Models of Care programme in January 2015. This aims to support delivery of the FYFV with 50 ‘Vanguard’ sites piloting joined-up working between local health and social care providers (NHS, 2015a; NHS, 2015b).
The drive toward integrated care was then further boosted by the Government’s Spending Review in November 2015. This document outlines an expectation for health and care to be integrated by 2020 (HM Treasury, 2015).
The above activity culminated in December 2015, as NHS planning guidance for 2016-2017 included a requirement for local areas to develop a Sustainability and Transformation Plan (STP) to accelerate implementation of the FYFV (NHS, 2015c). There are 44 STP areas in England and each cover a unique geographical area referred to as an STP ‘footprint' (NHS, 2016a). STPs provide a planning framework and discussion forum for commissioners, providers and stakeholders to shape their local health and care system and deliver integrated services (Alderwick et al, 2016). However, STPs are not statutory bodies. Thus, each participating organisation must adhere to their existing legal responsibilities during the design and delivery process and STPs must receive sign-off from the respective local authority to implement their planning a outlined in the STP document (NHS, 2016b).
From April 2017, STPs will be the sole application and approval process to access NHS Transformation Funding and STPs are scheduled to be fully implemented by 2021 (NHS, 2015c). It is of note that STPs do not replace Vanguards and the planning framework is intended to facilitate the development and spreading of new care models (NHS, 2016a).
Importantly, within the nine ‘must do’s’ for the period 2017 to 2019 is an explicit requirement for all local areas implementing the FYFV to maintain a two-thirds diagnosis rate for dementia and have due regard for NHS guidance on improving post-diagnostic support (NHSE and NHS Improvement, 2016). This focus on dementia is interlinked with the sustainability and transformation process and continues to implement the Prime Minister’s challenge set in March 2015 to make England the best country in the world for dementia care and support by 2020 (Department of Health, 2015).