Place-based care
Written by Dr Kat Deerfield and edited by Dr Eleanor Johnson and Dr Grace Krause
February 2024
In this evidence summary, we highlight relevant and up-to-date research on place-based care and its role in social care provision in Wales.
Place-based care is an approach to delivering social care that uses the resources of local communities to meet the individual needs of people using care services. This approach helps make sure that everyone involved in providing care and support can work together within communities, so that people can access the right care at the right time. Place-based care has received growing attention in Wales recently, but it’s not a completely new way of working.
Introduction
Place-based care is an approach to delivering social care that meets people’s unique needs by using the resources of the community where they live or that they feel connected to.
Place-based care focuses on the resources available in an area to make sure that people get the right care, in the right place, and at the right time. It promotes effective multi-agency working, improves outcomes for people accessing all types of care and support, and makes sure that resources are used in the most efficient and cost-effective ways.
There’s evidence that place-based interventions can have positive outcomes. These include fewer visits to accident and emergency and reduced waiting times for health assessments. People involved in place-based interventions also report higher satisfaction with the support they receive (Thiel et al. 2013, Parsons and Wade, 2023). Place-based care can also help with value for money by getting the right resources to the right people and preventing further health and care needs from developing (Thiel et al., 2013; Munro, 2015; NHS Confederation, 2020).
A focus on place aims to reduce differences in outcomes between people living in distinct locations or belonging to different socioeconomic groups. It aims to do this by targeting interventions where they are most needed and delivering care and support using the resources available in each place (Naylor and Charles, 2022; McGowan et al., 2021).
Place-based care involves using local resources to make sure people get the right care
What do we mean by place-based care?
Place-based working focuses on providing care that considers a person’s community: the place they live, spend their time, or feel a part of. Focusing on the places that are important to people makes it possible to make connections between all types of care and support that are available in a community. It also helps both workers and community members to make connections between their local knowledge. This is valuable because making it easier for different organisations to work together leads to better outcomes for people accessing services (NHS Confederation, 2020).
You could argue that all social care is place-based, because it happens in someone’s home or in another community space (Ratliff et al., 2023). But when we talk about place-based care, we mean collaborative working where multiple agencies, organisations, and individuals in an area come together to deliver care, especially when the local community is involved (Munro, 2015).
The ‘place’ in place-based care often refers to a physical location. This may seem obvious, but it can still be interpreted in more than one way, and this leads to some inconsistency within health and social care research. For example, the NHS defines ‘place’ as any geographical location with a population of 250,000 to 500,000 people (NHS Confederation, 2020). However, many place-based approaches focus on smaller communities, and sometimes local authority boundaries are used to define ‘place’ regardless of population (Naylor and Charles, 2022).
In some research, there’s more focus on people’s ‘sense of place’ than on a particular location. This involves considering how people feel connected to their community rather than focusing on just the physical area (Ratliff et al., 2023). Even the idea of ‘community’ can have multiple meanings. ‘Communities of place’ is the term used by Welsh Government to talk about groups of people who share a location, while ‘communities of interest’ is used for groups of people who share an identity but may or may not spend time in the same location (Welsh Government, 2021). Place-based working can prioritise both the location where a person spends their time and the communities they’re a part of.
Place-based care has recently become a more common term, but this way of working isn’t completely new. Any intervention or project that focuses on a specific location is a kind of place-based working, and these place-based approaches have been used throughout the UK for over 50 years (Baker, 2022). In 2014, Regional Partnership Boards were established as part of the Social Services and Well-Being (Wales) Act 2014. They’re one example of how place-based working already happens at the regional level in Wales. At the local level, there are also many existing community projects that are examples of place-based care taking place in Wales (Baker, 2022; Easterbrook and Blood, 2022).
Place can mean both ‘location’ and ‘community’
Place-based care in Welsh legislation and guidance
The Social Services and Well-Being (Wales) Act 2014 (SSWBA) sets out the legal framework for supporting the well-being of everyone who needs care and support in Wales. Place-based care is one way of supporting the goals and duties set out in the Act. The Act includes four fundamental principles for social care. Place-based care can address all four:
- voice and control
- Place-based care focuses on supporting an individual’s goals for their care, which means their voice and control over their circumstances is front and centre
- prevention and early intervention
- Place-based care is designed to make sure that people access the right care at the right time, avoiding worse outcomes and reducing the use of emergency services
- well-being
- Place-based care encourages focusing on what well-being means in each individual’s circumstances, including how their local community supports their well-being
- co-production
- Place-based care creates and supports opportunities for all the organisations and individuals involved in care and contributes to the development of good practice.
The SSWBA also set up Regional Partnership Boards, which bring together multiple organisations and members of the community to work on developing region-specific approaches to fulfilling the Act’s well-being requirements.
The policy framework for care provision in Wales is outlined further in A Healthier Wales (2018), which sets out several programmes that support place-based care. These include:
- Strategic Programme for Primary Care (SPPC)
- Urgent and Emergency Care Programme
- Health and Social Care Regional Integration Fund
All these policy frameworks are designed to support individuals who need care by focusing on each person’s needs, preferences, and goals. They’re also designed to support people in ways that consider the local area where they live or spend their time. This includes supporting people to stay in or near their homes for as long as possible.
The Welsh Government initiative Further Faster aims to support the goals established in the SSWBA and in A Healthier Wales for place-based care provision. It will provide funding and a policy framework to support place-based working in care provision for older adults across Wales (Hywel Dda UHB, 2023b).
The announcement of Further Faster led to a lot of discussion about place-based care. But not everything about place-based working is new, and research about place-based care doesn’t just focus on changing care delivery. A lot of research focuses on how care is already being done in a place-based way. And more research is needed to capture all the good practice in place-based care delivery that’s already happening (Evans et al., 2017; Baker, 2022; Ratliff et al., 2023).
Place-based care uses local knowledge to set up systems of care
Key principles of place-based care
Place-based care can be delivered in different ways depending on the context and needs of the community. Using local knowledge to set up systems of care with local resources is a key strength of place-based care. But this also means that there isn’t a one-size-fits-all approach to place-based care delivery. One strategy can’t just be ‘transported’ from one location and made to work effectively in another (Goodwin et al., 2013).
Research evidence does provide some general principles that are important for delivering good place-based care. These include:
- prioritising the individual outcomes of each person needing support (Munro, 2015)
- creating an environment or structure where organisations and individuals can work closely together on local needs (Munro, 2015; Baker, 2022)
- making the relationships between organisations clear so that everyone understands how referrals and data are shared (Baker, 2022; Parsons and Wade, 2023)
- making sure that discussions are open to everyone’s views and creating ‘safe places for debate’ (Munro, 2015).
Place-based care overlaps with multi-agency partnership working because the focus on place emphasises how all the sources of support within an area can work together. Social care professionals who work in a place-based way may work with professionals from the health, housing, education, youth, and criminal justice sectors, as well as with a range of community organisations.
Place-based initiatives can come from either a ‘top-down’ or a ‘bottom-up’ approach. In a ‘top-down’ approach, government shapes the approach and sets out its aims for the work (Baker, 2022). A ‘bottom-up’ approach is based on the knowledge and resources that exist in a community. It puts the focus on these strengths, rather than on what people might feel the community is lacking (Munro, 2015). A ‘bottom-up’ approach also recognises regional inequalities (McGowan et al., 2021).
What does a place-based approach to care involve?
Place-based workforce strategies
Place-based care is about using local resources and local knowledge to address local needs. A lot of the work that goes on within communities is already place-based in nature, so place-based working is often about supporting all types of work by facilitating connections within existing communities (Munro, 2015; Ratliff et al., 2023).
There isn’t currently much research about what training and development would help the social care workforce to deliver effective place-based care. One study on the development of place-based learning methods found that successful approaches focused on (Germaine et al., 2022):
- ‘people-centred learning’ – making sure everyone’s individual knowledge and experience is valued in the learning process
- developing ‘cultures of teamwork’ to support learning
- creating networks to support shared learning.
These three points emphasise the value of multiple perspectives, bringing together people who have different kinds of expertise, and supporting everyone to learn together (Germaine et al., 2022).
Place-based recruiting is another way place-based principles relate to workforce development. Place-based recruiting means focusing on recruitment from within a local area. This also means using local knowledge to develop effective ways to recruit people into social care roles. Place-based recruiting is one way of responding to the attraction and recruitment theme of A Healthier Wales: Our Workforce Strategy for Health and Social Care (HEIW and Social Care Wales, 2020).
Place-based funding
Often, different agencies work from different sources of funding that have separate application processes, requirements, and timescales. This can make working smoothly across different teams more challenging. Place-based funding models can help to address this by providing funding to strengthen specific communities or areas. This avoids resources only being directed to the individual partners carrying out the work (LGA et al., 2018; Baker, 2022). Findings from evaluations of some place-based approaches suggest this kind of place-based funding model can help make it easier for multiple agencies to work together effectively (Baker, 2022). More research needs to be done to understand the most efficient ways to fund place-based care.
For place-based care to be successful, individuals and organisations also need to know what funding and resources are available in an area. One way of doing this might be to create resources that address this need. Further Faster aims to support place-based working by using a digital-first approach that will include setting up centralised resources that make it easier to find support. This is designed to make every part of the care journey easier for all types of providers by increasing awareness and improving accessibility of resources (Hywel Dda UHB, 2023b).
Research tells us that place-based care can lead to better outcomes
Does a place-based approach to care work?
Social care delivery in Wales is seriously impacted by wider factors including reduced public services funding, the UK’s withdrawal from the EU, the COVID-19 pandemic, and climate change. Also, economic inequality between regions is exceptionally high throughout the UK, and Wales has seen less recovery from the 2008 financial crisis than England, Scotland, and Northern Ireland (Baker, 2022).
These challenges are widespread but affect some communities more than others (Thiel et al., 2013; Baker, 2022). Social care has a vital role to play in addressing wealth inequality, racism and discrimination, and exclusion and isolation, at the same time as meeting individuals’ direct care needs. Research suggests that place-based care can help us to recognise the links between an individual’s needs, their local standards of living, and the experiences of their wider communities (Baker, 2022; McGowan et al., 2021; Ratliff et al., 2023).
A place-based approach to care can help respond to many challenges because it encourages the development of a shared focus and a shared language across multiple agencies and communities (Munro, 2015). An awareness of local issues – including both resources and challenges – can help make sure that everyone works to tackle problems effectively by working together (Munro, 2015; McGowan et al., 2021).
Research tells us that place-based care can:
- support effective multi-agency working
- lead to better outcomes
- provide value for money.
Supporting multi-agency working
Successful place-based working needs the organisations and individuals involved in supporting care to work together. At the same time, place-based working is one framework that can make multi-agency working easier by encouraging a shared focus on place. Having this shared focus makes it easier to provide the right care in the most efficient way (Goodwin et al. 2013; Baker, 2022).
Effective multi-agency working relies on shared knowledge and understanding of what resources are available. Place-based work involves planning how knowledge and understanding can be shared between agencies. Looking at a place-based health and social care partnership, Parsons and Wade (2023) found that nurses didn’t always know what to do about ‘non-clinical’ issues that weren’t considered to be safeguarding concerns. That uncertainty sometimes meant that nurses weren’t able to make referrals when social care support was needed. In the place-based team, connections and conversations that happened between workers through the place-based partnership helped each group understand what everyone could offer. This allowed the right support to be made available for a wider range of care needs (Parsons and Wade, 2023).
Parsons and Wade (2023) found that, as the success of the initiative became clear, more and more agencies got involved. They also found that attendance at team meetings stayed high for all organisations and individuals involved (Parsons and Wade, 2023). This suggests that place-based approaches can help to make sure multiple agencies talk to each other and work together.
Focusing on place aims to reduce differences in outcomes between different regions and groups
Improving outcomes
Research suggests that place-based care can improve outcomes for people who access support. Place-based approaches are designed to build on local knowledge and recognise local needs (Goodwin et al., 2013). This makes it easier for people to access the support they need, when they need it. Getting people access to the right local support means they can be more involved in decisions about their care. Research findings suggest that the different types of support offered by place-based teams can help individuals recognise and make their own choices about accessing care (Parsons and Wade, 2023).
Improved outcomes mean different things to different people, so measuring the success of place-based interventions can be challenging. But there’s evidence that place-based interventions reduce visits to accident and emergency and that they reduce waiting times for health assessments (Parsons and Wade, 2023). People also report feeling more independent and more satisfied with care and support (Thiel et al., 2013). Place-based care is also linked to better cost efficiency and more capacity for preventative working, because the right resources go to those who need them (Thiel et al., 2013; Munro, 2015; NHS Confederation, 2020).
Focusing on place aims to reduce differences in health and care outcomes between different regions and groups. Delivering interventions in specific areas and leaning on local understanding of local needs tackles inequality by ensuring that support is provided where it’s most needed and with maximum efficiency (Naylor and Charles, 2022; McGowan et al., 2021).
There’s evidence that focusing on place and community is particularly important in social care for older adults. Research on well-being and health for older adults shows that people have better outcomes when they can stay at home and in their local community for as long as possible. These outcomes include (NHS Confederation, 2020; Robertson et al., 2020):
- avoiding unnecessary hospital admissions
- reducing isolation
- supporting a sense of community connection in later life
- reducing hospital stays for people who are ready to be discharged.
Place-based care mainly focuses on supporting people to stay in their own homes, but also allows for models of residential care that are integrated into the broader community. Place-based working doesn’t need to stop just because an individual moves to a different setting. And place-based approaches allow for recognition that everything exists within a community – including care settings outside of the home (Evans et al., 2017).
Providing value for money
Limited social services resources can make it challenging to effectively support people’s holistic needs (McGowan et al., 2021; Baker, 2022). Where funding is made available for place-based care, like the funding provided through Further Faster, this directs resources towards preventative community services (Hywel Dda UHB, 2023b). Community care services that use a place-based approach can build on local resources and knowledge. This can make all the difference when resources are limited and make sure they’re used as efficiently and effectively as possible (Thiel et al., 2013; Baker, 2022).
More research is needed to show how exactly place-based care can lead to cost savings (McGowan et al., 2021). But some research shows that place-based working can save money through reducing hospital admissions and avoiding unnecessary time in hospital (Thiel et al., 2013; Munro, 2015). Costs can also be saved by bringing the organisations working within a community together, so that the most appropriate support is used in the most efficient way possible (Munro, 2015; Parsons and Wade, 2023).
Conclusion
The Further Faster initiative has given more attention to place-based care provision in Wales. Place-based care is one way of making sure that care responds to the individual needs of people within a community. It’s also a way to support effective working between the many organisations and individuals involved in supporting everyone’s health, safety, and well-being. Research suggests that place-based approaches can help with many of the challenges now facing the care sector. Research also suggests that more community-based working will lead to better outcomes for those accessing care and support.
Additional reading
Here is a list of the five most relevant resources to place-based care that are either open access or freely available on the NHS Wales e-Library.
- Baker, S. (2022) A scoping review of place-based approaches to community engagement and support, Welsh Government, available at https://www.gov.wales/sites/default/files/statistics-and-research/2022-06/a-scoping-review-of-place-based-approaches-to-community-engagement-and-support.pdf (accessed: 23 May 2023).
- McGowan, V., Buckner, S., Mead, R., McGill, E., Ronzi, S., Beyer, F. and Bambra, C. (2021) ‘Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review’, BMC Public Health, 21 (1), doi:10.1186%2Fs12889-021-11852-z, available at https://doi.org/10.1186%2Fs12889-021-11852-z.
- NHS Confederation. (2020) From place-based to place-led: a whole-area approach to integrating care systems. https://www.nhsconfed.org/publications/place-based-place-led (accessed: 23 May 2023).
- Parsons, J. and Wade, S. (2023) ‘Making a success of a place-based team’, Journal of Community Nursing, 37(1), pp. 59-64, available at https://www.proquest.com/docview/2779943795.
- Robertson, J. M., Gibson, G., Greasley-Adams, C., McCall, V., Gibson, J., Mason-Duff, J. and Pengelly, R. (2022) ‘“It gives you a reason to be in this world”: the interdependency of communities, environments and social justice for quality of life in older people’, Ageing & Society 42 (3), pp. 539-563. doi:10.1017/S0144686X20000859, available at https://doi.org/10.1017/S0144686X20000859.
Reference list -
Baker, S. (2022) A scoping review of place-based approaches to community engagement and support, Welsh Government, available at https://www.gov.wales/sites/default/files/statistics-and-research/2022-06/a-scoping-review-of-place-based-approaches-to-community-engagement-and-support.pdf (accessed: 23 May 2023).
City and County of Swansea (2022). Minutes of the Scrutiny Performance Panel – Adult Services, 27 September 2022, Swansea, available at https://democracy.swansea.gov.uk/documents/g10961/Pecyn%20adroddiadau%20cyhoeddus%20Dydd%20Mawrth%2008-Tach-2022%2016.00%20Panel%20Perfformiad%20Craffu%20-%20Gwasanaetha.pdf?T=10&LLL=1 (accessed: 14 July 2023).
Easterbrook, L. and Blood, I. (2022, unpublished) Scoping how we can support the development of different workforce and care service models within communities across Wales.
Evans, S., Atkinson, T., Darton, R., Cameron, A., Netten, A., Smith, R. and Porteus, J. (2017) ‘A community hub approach to older people’s housing’, Quality in Ageing and Older Adults, 18(1), pp. 20-32. doi:10.1108/QAOA-02-2015-0008.
Firmin, C., Curtis, G., Fritz, D., Olaitan, P., Latchford, L. and Larasi, I. (2016) Towards a Contextual Response to Peer-on-Peer Abuse: Research and Resources from Misunderstood Local Site Work 2013–2016, University of Bedfordshire, available at https://www.contextualsafeguarding.org.uk/media/ie2kygq4/towards-a-contextual-response-to-peer-on-peer-abuse_161013_170057.pdf (accessed: 23 May 2023).
Germaine, R., Manley, K., Stillman, K. and Nicholls, P.J. (2022). ‘Growing the interprofessional workforce for integrated people-centred care through developing place-based learning cultures across the system’, International Practice Development Journal, 12(1). doi:10.19043/ipdj.121.004.
Goodwin, N., Sonola, L., Thiel, V. and Kodner, D.L. (2013) Co-ordinated care for people with complex chronic conditions, The King’s Fund, available at https://www.kingsfund.org.uk/insight-and-analysis/reports/developing-community-resource-teams-pembrokeshire-wales (accessed: 1 March 2024).
Health Education and Improvement Wales (HEIW) and Social Care Wales (2020) A Healthier Wales: Our Workforce Strategy for Health and Social Care, available at https://socialcare.wales/cms-assets/documents/Workforce-strategy-ENG-March-2021.pdf (accessed 4 July 2023).
Hywel Dda University Health Board (UHB) (2023a) Health Minister praises partnership working at community hospital, available at https://hduhb.nhs.wales/news/press-releases/health-minister-praises-partnership-working-at-community-hospital/ (accessed: 14 July 2023).
Hywel Dda UHB (2023b) Up to £30m investment in community care to reduce pressure on hospitals, available at https://www.gov.wales/30m-investment-community-care-reduce-pressure-hospitals (accessed: 14 July 2023).
Local Government Association (LGA), Association of Directors of Adult Social Services, NHS Clinical Commissioners, NHS Confederation, NHS Providers and Association of Directors of Public Health (2018) Shifting the centre of gravity: making place-based, person-centred health and care a reality, available at https://www.local.gov.uk/sites/default/files/documents/1.84%20-%20Shifting%20the%20centre%20of%20gravity%20WEB_0.pdf (accessed: 23 May 2023).
McGowan, V. J., Buckner, S., Mead, R., McGill, E., Ronzi, S., Beyer, F. and Bambra, C. (2021) ‘Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review’, BMC Public Health, 21 (1). doi:10.1186%2Fs12889-021-11852-z.
Munro, F. (2015) Place-based working, IRISS, available at https://www.iriss.org.uk/sites/default/files/2016-07/iriss-on-placebasedworking-08-2015-2.pdf (accessed: 23 May 2023).
Naylor, C. and Charles, A. (2022) Place-based partnerships explained, The King’s Fund, available at https://www.kingsfund.org.uk/publications/place-based-partnerships-explained (accessed: 23 May 2023).
NHS Confederation (2020) From place-based to place-led: a whole-area approach to integrating care systems, available at https://www.nhsconfed.org/publications/place-based-place-led (accessed: 23 May 2023).
Owens, R. and Lloyd, J. (2023) ‘From behaviour-based to ecological: Multi-agency partnership responses to extra-familial harm’, Journal of Social Work, 23(4) doi:10.1177/14680173231162553.
Parsons, J. and Wade, S. (2023) ‘Making a success of a place-based team’, Journal of Community Nursing, 37(1), pp. 59-64, available at https://www.proquest.com/docview/2779943795.
Ratliff, G. A., Graaf, G. and Choy-Brown, M. (2023) ‘Orienting social work to incorporate place-based principles: A practical guide to the use of place in social work practice’, Journal of Social Work, 20 March 2023. doi:10.1177/14680173231162537 (accessed: 23 May 2023).
Robertson, J. M., Gibson, G., Greasley-Adams, C., McCall, V., Gibson, J., Mason-Duff, J. and Pengelly, R. (2022) ‘“It gives you a reason to be in this world”: the interdependency of communities, environments and social justice for quality of life in older people’, Ageing & Society 42 (3), pp. 539-563. doi:10.1017/S0144686X20000859.
Social Care Wales (2023), The Social Services and Well-Being (Wales) Act 2014 Overview, available at https://socialcare.wales/resources-guidance/information-and-learning-hub/sswbact/overview (accessed: 24 July 2023).
Thiel, V., Sonola, L., Goodwin, N. and Kodner, D.L. (2013) Developing community resource teams in Pembrokeshire, Wales, The King’s Fund, available at https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/pembrokeshire-coordinated-care-case-study.pdf (accessed: 23 May 2023).
Welsh Government (2018) A healthier Wales: long term plan for health and social care, available at https://www.gov.wales/healthier-wales-long-term-plan-health-and-social-care (accessed: 24 July 2023).
Welsh Government (2020) Regional partnership boards (RPBs), available at https://www.gov.wales/regional-partnership-boards-rpbs (accessed: 24 July 2023).
Welsh Government (2021) A More Equal Wales, The Socio-economic Duty Equality Act 2010. Statutory Guidance, available at https://gov.wales/sites/default/files/publications/2021-03/a-more-equal-wales.pdf (accessed: 23 May 2023).
Welsh Government (2022) Health and Social Care Regional Integration Fund, available at https://www.gov.wales/health-and-social-care-regional-integration-fund (accessed: 24 July 2023).
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