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. It 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.
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.
- Greater Manchester ('Devo Manc')
First announced in November 2014 on the basis of a mayor being elected (May 2017, Greater Manchester was offered the broadest devolution deal to date, including powers over transport, planning and housing as well as uniting 38 different organisations as part of health and social care devolution plans. The Greater Manchester footprint covers 2.8 million residents in a monocentric city region with a compact geography, and with a number of economic and clinical interdependencies and flows.Greater Manchester now controls long-term health and social care spending, ready for full devolution of a budget of around £6 billion in 2016/17.Health and social care
- RCN South West Region
With much of the devolution focus on urban areas and the ‘northern powerhouse’, Cornwall was the first rural county to reach an agreement in July 2015. It includes responsibilities for apprenticeships, European Union structural funds, business support services, franchising of bus services, and a ‘One Public Estate’ initiative. Cornwall is the largest rural unitary authority in the country and has a considerably smaller population than Greater Manchester, at just under 550,000, greatly dispersed across the length and breadth of the region. Boundaries are coterminous, so devolution will involve a single council, Clinical Commissioning Group, Health and Wellbeing Board, acute trust, mental health trust, community provider and GP federation.
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.