An integrated approach to health and social care

Involving the voluntary sector

After attending many partnership meetings over the years, I am beginning to see some real progress when we talk about integration. Previously, integration was focused on how health and social care could work together to best support the people who need support for their health and wellbeing.

Now, there is more discussion about how voluntary organisations could – and do – support people with health and social care needs, working with statutory agencies to ensure that our services are joined up more effectively. RVA works on behalf of the voluntary sector to ensure that our partners are aware of how voluntary organisations can contribute, trying to get relevant VCOs involved at an early stage in the design of services and pathways to support people with health and social care needs.

Care and Support Plans for people with long-term conditions

There is ongoing work to support people who are living with one or more long-term conditions (LTCs). Long-term conditions include diabetes, chronic obstructive pulmonary disease, arthritis and hypertension – basically any health condition that someone has to live with. Berkshire West Clinical Commissioning Group (CCG) is supporting GP practices to introduce Care and Support planning for people with LTCs. For example, someone with diabetes will be invited to a review meeting and agree goals to improve their health, including diet and exercise, and look at the support which is available to help them achieve those goals.

Currently the support offered is often a service commissioned by the CCG or Public Health such as Eat for Health, SmokeFreeLife or Let’s Get Going. However, although many local voluntary organisations also support people to take more exercise, eat more healthily, and generally make healthy lifestyle choices, GP practices don’t always know about them.

We are now talking to the CCG about how the voluntary sector can be involved in patients’ Care and Support plans. This may via the three social prescribing services across Berkshire West (Community Navigators in Wokingham and Village Agents in West Berkshire), which link patients with community activities to support their goals.

Integrated Care Planning

The voluntary sector has the opportunity to be involved in Integrated Care Planning, a multi-disciplinary approach to achieve better health and wellbeing outcomes for people in Reading. The approach, being piloted in Reading, will bring together Health and Social Care practitioners with the voluntary sector (via RVA initially) to discuss people with complex needs who would benefit from a collective review of needs and a joint plan for addressing needs.

People with complex needs can receive support from various statutory agencies and voluntary organisations. The aim of Integrated Care Planning is to provide a personalised  and coordinated health and social care service that people need, achieving better outcomes for people, improving communications and preventing duplication of work.

And finally…

The Care Quality Commission has published Beyond Barriers:how older people move between health and care in England, with the following recommendations:

  • Reform of planning and commissioning of services. An agreed joint plan, funded in the right way, should support older people in their own homes, help them in an emergency, and then to return home safely.
  • A new approach to system performance management. This would measure how organisations collectively deliver improved outcomes for older people.
  • Joint workforce planning. This would allow flexible and collaborative approaches to staff skills and career paths.
  • Better oversight of local system performance. New legislation so CQC could regulate how people and organisations work together to support people to stay well.

This makes a worthwhile read.





Sarah Morland

As RVA's Partnership Manager, I seek and develop cross-sector partnership opportunities, facilitating communications between the voluntary sector and statutory agencies. I give advice and support on: planning, developing and promoting services and measuring impact.