- 10 May 2017
- Posted in: Healthcare, Education
As we approach the general election on 8 June, all political parties will look again at their various pledges around public sector reform, especially key areas of expenditure – the NHS, social care, housing, welfare reform, education and criminal justice.
The models and ideology around the integration or the transformation agenda around service delivery and commissioning will be even more paramount as we move towards a future post-Brexit where there will be greater pressure around realignment of public expenditure and the state of the economy.
“We now have established a clear body of evidence of the housing offer to the NHS.”
Despite all of the talk for trade deals, more inward investment and searching for new global markets outside the EU, we have still not achieved the full integration of health and social care.
While working for the National Housing Federation for almost four years as part of the policy team, we have been able to play an important role in positioning members to explore and develop sectoral housing offers around public health, mental health, learning disabilities, hospital discharge, older people, equalities and the use of NHS land for affordable housing.
We also developed a number of big ideas and conversations with a range of stakeholders, bringing senior leaders together from across the health and housing worlds.
One of the key challenges facing the housing sector as we tried to engage and bridge the gap with NHS commissioners and providers who hold the purse strings is facing up to the medical model of intervention.
The housing sector was constantly questioned around relevant evidence, commitment and understanding of NHS cultural norms which is often embedded in the business case.
This at times required some degree of soul-searching in how seriously housing wanted to be part of this commissioning world and also whether we could influence or challenge the status quo.
We commissioned a number of respected organisations and consultants (HACT, Sitra, the NHS Alliance, Frontier Economics, Housing LIN (Learning and Improvement Network), The King’s Fund, the London School of Economics, Sheffield University and Durham University) in pulling together the key elements of evidence and best practice to support a business case that members could use or adapt at a local and regional level.
I believe that we now have established a clear body of evidence of the housing offer to the NHS covering the types of service that can be provided, the cost savings and wider social impact and quality of services.
In most of our recent briefings and reports, we have been able to pull together the key elements of a business case that should be presented to commissioners in developing a strategic relationship with a housing provider.
Key questions include:
• Who do you face (in health)? What is their context? What are their drivers?
• Do they know enough about you to trust you?
• What’s your logic model for your intervention?
• How are you measuring the outcomes identified and defined by your logic model?
• What type of economic evidence will be most appropriate and persuasive?
• How will you present this to health to make the best business case possible?
We now need to move beyond the rhetoric of the emotional and moral case around health and housing integration and commissioning which is reflected in the memorandum of understanding that was signed by the housing and health sector more than two years ago.
We require a fundamental shift of collective leadership and action around transformation change.
Perhaps we may have to adopt some of the lessons or language of Brexit in looking at ‘hard’ or ‘soft’ integration as a way of focusing the minds in how we can deliver better public services by helping the NHS to reduce the financial pressures and demand levels, so it can be more sustainable and deliver even greater patient outcomes.