Housing and Health – why integration matters: the challenges that are driving the need for integration

The direction of travel for health services is pretty clear… and surprisingly unambiguous in describing the way services need to change. Wellness, out of hospital care, early intervention, prevention and integration.

Without change – and these changes need to be truly transformational – the NHS will fail to meet the needs of either austerity, or the increasing demands of an ageing population. We are living longer, with more co-morbidities, and our system of healthcare needs to shift from hospital to home, be better integrated across health and also between health and wider public services.

From an insular health service there is an increasing recognition that we need an integrated approach, one that encompasses not just social care but welfare and a holistic approach to the wider needs of vulnerable groups that includes their housing needs.

These changes are beginning to happen but it is patchy and entry points are not always easy to see from outside. There is little in the way of central mandates so change is happening piece-meal through commissioners that are more fragmented than they were and are organisationally still relatively immature

What does this mean for Registered Providers

The housing sector has to change to meet its challenge of providing fit for purpose accommodation for the old and infirm and to work closely with the health and social care sectors to ensure its tenants are able to access the support they need in as straightforward and cost-effective manner as possible.

Despite some obvious inhibitors there are genuine opportunities opening up for RPs, particularly those RPs that provide a wider breadth of social services.

Opportunities for Registered Providers

The Better Care Fund (BCF) and Transforming Community Services (TCS) refresh (i.e. the need to competitively tender the old PCT community services) are good examples and are building pressure to change from commissioners already struggling to transform services through the use of outcome based contracts (such as the Capitated Outcome Based Incentivised Contracts being explored in Cambridgeshire, Staffordshire and beyond).

And on the NHS provider side the number of financially distressed Trusts is growing with a growing number of sub-specialist District General Hospitals recognising that now they need to radically transform themselves into something that is more akin to a health and social care hub and spoke. Most NHS provider's also know that they need to work in partnership with specialist providers including RPs – but are not always clear about how and in what form to access it.

Our experience

At Bevan Brittan we are helping NHS providers to find effective ways respond to these changes through:

• Innovative partnership models. Joint working that shares risk and reward between public and private and gives the NHS access to independent sector capacity and capability. From estates (where we have seen an explosion in the use of the Strategic Estate Partnership model of joint working through a corporate JV) to clinical support services such as pathology to patient hotels intermediate and step down care
• SIBs (Social Impact Bonds). Used to fund the double running cost of transformation where in-year cashable savings are insufficient to fund the cost of new interventions
• New models of contracting, from COBICs to Alliance and all the shades in-between
• Managing complex procurements successfully, often with the complexities of bidding as part of a consortium that might include other NHS or independent sector providers
• Outsourcing from NHS Trusts, struggling to deliver efficiency savings and willing to consider private sector involvement on a much broader scale and range of services than was hitherto the case. Trusts are following the local government lead and are willing to consider partnering or outsourcing services that go well beyond the traditional back office services of FM. Our specialist skills can help manage not only the procurement but the optimum balance of risk and reward between pure outsourcing and a genuine partnership.
• Commercialisation opportunities. From Private Patient Units, franchising, patient hotels, research and life science parks, pathology to a recognition that many District General Hospitals can (and should) expand into Health & Social care campuses that offer a range of uses that meet broader benefits for vulnerable groups – extra care and supported living being a good example
• The increasing complexity of the regulatory environment from the imminent changes in procurement law to competition law and the requirements of Monitor and Care Quality Commission

How we can help

The health market is one that is undergoing radical change, genuine opportunities and where our expert help to shape your market entry points to exploit these changes can make a real difference.

We would be delighted to come and meet you to explore your current thinking and to share our thoughts. Please do get in touch.