What do we mean by place? There is much talk across health and social care about the future being “place-based” and it is not always easy to grasp what this is all about.
Here is an introduction to get you going:
“A simple proposition lies at the heart of place-based care: that we blur institutional boundaries across a location to provide integrated care for individuals, families and communities. Energy, money and power shifts from institutions to citizens and communities. Devolution becomes an enabler for a reform programme that starts to deliver on the long-held promise of joining up health and social care for a population in a place, with the ultimate aim to improve the public’s health and reduce health inequalities.”(1)
There is added value in:
- “collaborating at different levels in the system
- building up from places and neighbourhoods
- providing leadership across the system
- focusing on functions that are best performed at scale” (2)
The King’s Fund offer the following definitions:
- System – area covered by Sustainability and Transformation Partnership (STP) or Integrated Care System (ICS) (size varies but they cover one to three million people)
- Place – area covered by local authority (tend to cover populations of around 250,000 to 500,000 people)
- Neighbourhood – smaller geography that might correspond to district council boundaries or covered by a primary care network (PCN) (tend to cover populations of around 30,000 to 50,000 people) (2)
What will this look like in practice?
Groups of organisations including NHS trusts and local authorities will work together as an STP to decide on priorities for their place, and this may evolve to form an ICS and work together more formally. This will mean people with local knowledge developing the right services for their population across a whole area. It is designed to acknowledge the fact these services are not experienced in isolation by the people using them – although they are run by separate organisations, the thing they all have in common is the people from that place. It may also mean trusts agreeing that staff can work across different sites, or for some highly specialised services to be offered by one trust rather than several.
National organisations such as HEE as well as NHS England and Improvement and Public Health England, have teams aligned to each STP or region. These teams will work as a link between the locally driven priorities, and nationally provided initiatives such as those to develop (in HEE’s case) the right workforce to meet the needs of each place as well as the country as a whole.
As a very simple (and entirely fictitious) example, Anytown identifies that they have an aging population and rates of dementia are predicted to increase. They need staff with the right skills to meet their population’s needs, to run the right services such as specialist dementia clinics. This local intelligence can be fed into national plans by HEE to create postgraduate courses for nurses to become specialist dementia practitioners with a number of places offered to nurses from the area. The same local intelligence also identifies that many of the city’s GP workforce is rapidly approaching retirement, and they could be facing a shortage soon. An initiative could see additional placements for trainee GPs offered, to help encourage new staff to consider moving to the local area.
So, it should mean greater collaboration between organisations within a particular area and ideally, seamless care for the person receiving it.
What might this mean for you in your library and knowledge service as you support place-based care?
Are there local partners who you need to work with to support and improve your offer across your STP or region?
- The journey to place-based health, Public Health Matters
- Health and Wellbeing boards and integrated care systems, The King’s Fund
Emily Hopkins and Katie Nicholas
Knowledge Management Service
Health Education England