Nana’s Golden Key

One of my colleagues was explaining last week why integration of health and social care is important. Tired of the usual cliches he decided to tell us what a carer had said to him. Let’s call her Nana. She described how her life had become blighted by the illness of her husband. How she had proudly resisted help until he became to much for her to cope with alone. She approached services and was given support. She said it was like

“I had been given a ring with 15 keys on it. But no-one told me which key opened which door. Or what was behind the doors.” It was frustrating and difficult. Then about a year ago services were integrated in one of our demonstrator sites.


She said “Suddenly I was given a golden key. It opened any door and gave me what I needed”.


Over the last two years, I have been writing about the risk of competition and fragmentation of commissioning on care. As part of a Future Forum submission, in briefings for the NHS Confederation, everywhere I could, I have worried about multiple providers serving multiple commissioners for a single patient journey leading to duplication and gaps. There has been a lot of change since. Those risks are receding.

Every day we hear about the importance of integrated services in the future NHS. The Government delivers a welcome £3.8bn pooled fund for integrated health and social care in the budget. Norman Lamb announced a number of “pioneers” to look at integrated health and social care systems – Leeds has submitted its bid along with, some say, around 100 others. Mark Britnell from KPMG – touted as future CEO of NHS England by the commentariat – writing in this month’s Health Services Manager says “Integration trumps competition in terms of delivering sustainable benefits”. Monitor sets out its thoughts on enabling integrated cares in its role as system regulator. The fabulous National Voices have come up with a new definition – at the heart of the vision in Leeds.

Person centred coordinated care

“I can plan my care with people who work together to understand me and my carer(s), allow me control, and bring together services to achieve the outcomes important to me.”

The integration lobby have won the argument, it seems. So why worry? Nana will get her golden key won’t she? Perhaps.

John Appleby writes in this blog about the role of the OFT and Monitor in ensuring appropriate competition. He argues well about the need to make a good case for not competing – with more than a golden key as support. The financial system still supports the delivery of funds to hospitals for activity or part funds urgent care to their detriment, depending on your view. Many agree it doesn’t yet support integrated care or continuity or shifts in care – good King’s Fund Report here.

Which leaves local leadership to sort things out. I have no problem with this. We must have faith in local System Leadership, which is essential in these circumstances. In Leeds we are working really hard to ensure that everyone plays a system leadership role. Our Health and Social Care Transformation Board helps to drive this. Its role in the integration of services has been fundamental to the progress to date. Local politicians have backed change. Commissioners have used the non-recurrent resources to fund change. Providers have thought about services first, not structures. Researchers have been working with us to assess the impact on quality and activity. Lots of detail here.

And change is beginning to happen. Beautiful, impactful, essential change. Change that happens in homes so is not visible enough. Change that transforms lives. Not enough yet to give every Nana a golden key but sufficient to be seen by those who matter. Take Elsie Sykes, one of our patients, talking about being “lifted” in the video on this page.

If you have watched this, you will understand why we must succeed. Because we all know an Elsie and we all have a Nana, don’t we?

5 thoughts on “Nana’s Golden Key

  1. A hopeful and inspiring blog: thank you!
    One of my “hats” is as VC of Healthwatch Leeds, and we’re keen to understand more about how people see this integration project working, also to give voice to their opinions and suggestions.
    We have a plan about how we want to involve people, but we have no planned events yet. This is definitely a priority. I would welcome any comments with suggestions and ideas that I can take back to HWLeeds about how to do this, and lets add this to the list of things to chat about next time we see each other!

  2. Pingback: Nana's Golden Key | Health Blog Round-up | Scoo...

  3. Pingback: Good News! People, Help the People & the NHS | Rob Webster

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