Making the Better Care Fund work locally

By Adam Fineberg | 21 January 2014

  • Adam Fineberg

I’m excited by the opportunity for transformation at the local area arising from the ensuing Better Care Fund, formerly the ‘Integration Transformation Fund’, having had a long-standing background working on public services advising nationally and locally on 'making things work better for local people'.

The overriding issue for me has been realising a greater degree of wellbeing for citizens by making things - public services - work better for them, with the tangential benefit of realising financial savings.

I have been through the cycles of improvement and change and am a keen advocate of supporting a "can do" rather than a 'can’t do' culture.

My specifically appropriate experience in relation to the task regarding the integration of health and social care, and across the wider local public service arena, has been my involvement in the initiation, design, development and rolling out of the Total Place way of working locally.

I feel that there is much to be gained from a lot of the work on the Total Place programme. This brought about a revolution in terms of a 360 degree exercise for public services and an appreciation of the attributes and outcomes arising from the historic, paternalistic, but initially well-intentioned, model for public service provision.

A universally changed approach to the design and provision of public services has come out of the learning and dissemination and local development work across the public services at the regional, sub-regional and local levels.

It is, perhaps, unfortunate that the health and social care integration agenda was not so strong at that time, as although many local health partners were involved with the Total Place work, there was not the stimulus in terms of an agenda and incentivisation for health partners to actively follow this practice through.

Perhaps, now is the opportunity to address this situation and through learning, demonstration and communications, highlighting the opportunity that the Integrated Transformation Fund provides for local areas to get on and undertake the necessary collaborative through the tiers and across the partners redesign work.

The work needs to be lead and signed off by health and wellbeing boards, with development work starting at the coalface and the benefit of the understanding that many people in the sector now have around the prevention, early intervention and primary service provision issues.

The boards have to develop an agreed, costed and deliverable plan by March 2014.

Local plans should be part of a five-year strategy for local health and care services from 2015. They prompt work to look beyond the immediate short-term pressures and develop a shared vision of what future local services should look like.

This, related to the work of the new What Works Centres – with especial focus on early intervention and on economic development - the Public Service Transformation Network (PSTN), about whose establishment I advised the DCLG, and the work of the pioneer projects for care integration, can perhaps result in the cultural revolution that NHS England is calling for.

Adam Fineberg is a leading innovation and change advisor, consultant and facilitator.

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