We identified that the new collaborative care planning consultation cannot easily take place without addressing all of the practice and organisational infrastructure that surrounds it.

The programme developed a systematic and practical approach to support this, described as the Year of Care house. 

The house with its walls, roof and foundations acts as a metaphor, as well as a checklist, emphasising the importance and inter-dependence of each element – if one element is weak or missing the service is not fit for purpose.

The key components are the person with a long term condition (LTC) being engaged and informed, working with healthcare professionals who are committed to partnership working. The framework shows that that this will only occur in practice if there are sound organisational processes that facilitate their interaction, built on the foundations of robust commissioning processes. 


The diagram illustrates the core features of the house surrounded by the details our pilot sites identified as important in practice for diabetes. Some of these will vary for other conditions and illustrates how the house is a flexible set of principles which can be adapted to differing conditions and different sites of care.

Our core training is designed to support teams to build their own house reflecting the need to link attitudes, skills and local infrastructure to deliver effective, collaborative and personalised care planning. 

The house has now been incorporated into a variety of policy documents including the NHS England's Transforming Participation in Health and Care guidance and the King's Fund Delivering better services for people with long term conditions. In these documents it is referred to as the 'House of Care'.