Comment: What the new health and social care model means for you

LAST year I wrote about why change was needed and what that meant in practice to enable us to move to a more sustainable model of health and care.

Since then, the headlines have been dominated by secondary and post-16 education. So it could easily have escaped the attention of some that the Committee for Health & Social Care received unanimous approval for its policy letter at the December 2017 States meeting. It was the culmination of eight months of joint working with the public, private and third sectors, service users and the wider community to design the new model. This was a good-news story, demonstrating a truly collaborative approach, and I should like to thank all those who worked with us to make it happen.

The final report runs to 124 pages and it would be impossible to go through every aspect of it here, so this article is designed to give you a flavour of what it’s about. If you’d like to find out more, please visit our website at www.gov.gg/healthtransformation – which also provides lots of background information.

Now there’s no point spending months designing a new model if you don’t know what you want from it. Outcomes mean more than buildings and organisations, after all. So, what did we want to achieve? We started by taking the principles from the 2020 Vision, which, as I have said previously, was an excellent document that had lain on the shelf for far too long. We then tested, amended and refined those principles following feedback, until we had finalised 10 key aims against which the model’s success would be judged. These are prevention, user-centred care, fair access to care, proportionate governance, direct access to services, effective community care, a focus on quality, a universal offering, a partnership approach and, last but by no means least, empowered providers and integrated teams.

Of course, that was just the beginning. Converting these aims into a new model was the next big task. We knew what was wanted, but how did we convert that into reality that took best practice and converted it to a Bailiwick setting? What we didn’t want was a greater bureaucratic structure. We were very much aware what we needed was a model that was appropriate and proportionate to the needs of the people of Guernsey and Alderney. Our question was, ‘what is it?’

Well, we’re calling it a ‘Partnership of Purpose’ that will bring together health and care providers physically, financially and virtually to deliver joined-up care centred on you. It will be a kitemark of quality health and care and will be most visible at community hubs that bring together providers in one place so you can access services directly. These hubs will be linked to the main PEH campus, with a satellite campus in Alderney.

The Partnership of Purpose will be responsible for providing a range of services that you will be able to access for free, or at subsidised rates, known as the universal offer. All of us will have our own care passport setting out what services we are personally entitled to, designed to increase transparency and fairness.

Partnership of Purpose, universal offer and care passport may be buzzwords but they are intended to convey meaning to what we are trying to do. Health care is full of jargon that can be impenetrable to most. Just read anything written by those working in the field and you will know what I mean. We have tried to put something together that is both comprehensive and comprehensible.

As I’ve said before, governments have historically focused little on prevention. However, we have now reached a stage where it will be impossible to develop a more sustainable health and care service unless we do something about it. That is why the Bailiwick Health and Wellbeing Commission will be so important. It will bring together the public, private and third sectors to help raise awareness, encourage healthy lifestyle choices and take proactive steps to improve general health and wellbeing, mentally and physically. The commission’s importance can’t be understated as it represents the first real opportunity to reverse the growth in non-communicable diseases and reduce the four in 10 of all cancers that are avoidable.

A user app will be available that will begin as a directory of services provided by the Partnership of Purpose, but will evolve to enable you to book an appointment directly and eventually become the primary means by which you will access your care passport.

Information, in all its forms, will be central to the transformation. Through technology, we can support you in the home, provide electronic access to your records and digitally signpost services.

Through improving our data we can better understand your requirements and respond accordingly.

Now, many think of Health & Social Care as a service provider, which is understandable as that is the most visible part of what we do. However, we also act as commissioner and regulator. These are crucial roles in ensuring high quality, effective and efficient services, but there can be issues in wearing all three hats and greater separation is desirable, especially when it comes to regulation. To address this we will be setting up an independent care regulator to provide appropriate and proportionate regulation that will apply to all providers of health and care in the Bailiwick, including those provided by the States of Guernsey.

The newly established CareWatch, comprising representatives from the Bailiwick community, will also have an important part to play in ensuring your voice is heard in the future.

Now you’d be forgiven for thinking this is another vision that won’t see the light of day. But, the work has already begun. We have brought our budget under control and with some of the savings have begun to reinvest funds in support of the Partnership of Purpose. This will continue in areas such as in the 1,001 days initiative, reablement service, community pain service and the Bailiwick Health and Wellbeing Commission.

We’ve started designing the new regulatory system and the details will be presented to the States this year. This year will also see the replacement of our outdated IT network as well as the commencement of the upgrade of our core software program, Trak. The first of our health-needs assessments, focusing on older people, will be carried out and we will begin to work on designing the Partnership of Purpose and Universal Offer. Along with the start of the PEH reprofiling project and identification of a principal community hub, this year will see a review of nurses’ pay and conditions, which the committee has been calling for since it took office.

So, there’s a lot to do, and at the same time we are managing ‘business as usual’. However, the clock is ticking and we can’t afford to wait as the gap between the cost of health and care and funding available over the next decade grows. Make no mistake, costs will rise – that is unless services are cut drastically and I don’t get the impression anyone wants to see that. To believe that HSC’s budget can be brought down further, on top of the near £4m. reduction this year, is to ignore the huge pressures impacting the service today.

What we need to do is ensure we have done all we can to manage that rise and we have a once-in-a-generation opportunity to do just that. It won’t be easy and it won’t happen overnight, but with States committees, private and third sector organisations, and each and every one of us working constructively together, I believe we really can transform health and care and create a model fit for the future.