A place-based approach to care aims to address systemic issues that impact on health and well-being at a neighborhood level, such as poor housing, social isolation, poor or fragmented services and limited economic opportunities, making sure services are accessible.
A place-based approach acknowledges the premise that individuals need to be a part of their health care and only a small percentage of good health outcomes are as a result of clinical interventions, most come from the wider determinants such as, housing, access to leisure and open space, employment and education.
Place-based care requires different organisations to work together and break down traditional barriers. It also requires commissioners to think more about how care is best delivered throughout various aspects of the pathways and commissioning services across primary and acute care and involve other services accordingly and wherever possible that care is close to where people live.
Place-based care incorporates the concept of ‘Population Health’ which involves segmenting the population into groups of people with similar needs to enable targeted interventions for both those population groups and the individuals within them.
Devolution of powers and funds from central government to local government has emerged as one of the Government’s flagship policies in relation to integration of health and social care.
What is devolution?
Through the Cities and Local Government Devolution Act 2016, decision making and service provision across a wide range of areas from health and social care to transport can now be done at a local level.
Devolution is about moving more power, and responsibility, down to regional and local government; and in some cases to NHS organisations such as Clinical Commissioning Groups (CCGs).
Devolution passes responsibility for funding from central government and this will also include any funding cuts.
The aim is that this will foster and support better integration across services, and encourage efficiencies and savings by permitting regions or city-regions to manage their own finances.
Devolving health care was not core to the original devolution agenda, which was focussed on driving local economic growth; however, the inclusion of health and social care in the Greater Manchester ‘Devo Manc’ agreement has paved the way for this.
The Government has also agreed to work with partners in Cornwall to transform health and social care services. Local partners and NHS England are developing a business plan to move progressively towards the integration of health and social care.
If you are a member of nursing staff working in England, it is important to know how placed-based commissioning and devolution might impact you and your patients.
Regional information is available here:
South East England
South West England
North West England
Information on developments in other regions of England will be available here soon.
You can contact your local RCN regional offices for more information.