PPL Perspectives

'Islands in the stream, that is what we are, no one in between, how can we be wrong?' - What is place based care and what is its potential?

04 April 2018

Jose Acuyo Cespedes, Analyst

ScenarioJoel is 75 years old, lives alone in the outskirts of a town and has heard about a new hobby-discovery service in the next town available to those aged 65 or over. Enthused by the news, he goes to his local bus stop only to find that no direct buses run to the service-centre. Joel is not well enough to walk a long distance to the next town and so he stays at home alone. Whose fault is this? The service provider? The local authority? The transport provider?

As our understanding of health systems becomes more sophisticated over time, and as new research comes to light, we are starting to realise that the health of an individual person is not only down to the healthcare system. The Dahlgren-Whitehead rainbow (see below) shows us just how many factors contribute to the health of our population – ranging from health services to education to housing. We then have to ask, if so many factors impact on population health, why are they all working within their own separate kingdoms? The answer? Introducing place-based care: a world in which services revolve around local population needs to produce better outcomes.

DWR6

So, what is place-based care?

Place-based care is the concept of different local organisations, including but not limited to health and social care, working together to improve the health of the local population, all whilst remaining financially sustainable.

This concept aligns closely with the new ‘Integrated care systems’ (ICS) which are currently being implemented across England. ICS will see health commissioners and providers collaborate with local authorities and other partners to take a shared responsibility for their local population. The ultimate aims of these systems are to keep the population healthier, in their own communities and out of acute services, thus being financially and operationally sustainable.

Scenario - So what does place-based care mean for Joel? It means that the hobby-discovery service provider will have worked alongside the transport provider and realised that they both have a significant role to play in keeping Joel healthy. Since they have shared outcomes, they will have realised that access to services is just as important as the service itself, resulting in Joel having easier access to the services he benefits from.

By beginning to roll out the new ICS across parts of the country, the message being sent by the NHS and local government is clear - collective action across organisations presents a real opportunity to improve population health by addressing the wider determinants of health.

Joel’s story is a small example of how place-based care can personalise services and improve user experience, thus improving health outcomes. Expanding this policy across the country provides a real opportunity to drive sustainable change and realising the vision set out in the NHS five year forward view: patients gaining control of their own care and breaking down the barriers in how care is provided.