About this work
The national context
Integration of health and care has been at the heart of local and national conversations across the sector for decades. Delivering better care that works seamlessly across all the services that an individual might need - hospitals, primary care, community providers, mental health services, ambulance, social care, along with wider partners such as the voluntary sector – is a central ambition for national policy makers and local practitioners alike.
Recent national policy
- Health and Care Act 2022 placing integrated care systems (ICSs) on a statutory footing from July 2022
- NHS England (NHSE) policy setting out aims of ICSs with place-based partnerships as their foundation
- Joining up care for people, places and populations: integration white paper setting out structural direction for place arrangements (2022)
- People at the Heart of Care: adult social care reform white paper (2021).
The Health and Care Act 2022 provides a new legislative framework to promote collaboration. Now, after years of development, ICSs are on a statutory footing. While key strategic decisions will be taken at a system level, and provider collaboratives are driving delivery and improvements for services best delivered at scale, there is also a national policy expectation that systems will work through sub-system geographies.
These places will lead and deliver much of the operational detail to make integration a reality through place-based partnerships. The integration white paper (February 2022) aims to further accelerate integration at place, with a focus on leadership, governance, budget alignment, and workforce at the local level.
Making integration a reality: from ambition to delivery
The journey from ambition to delivery is one of the greatest current challenges facing policymakers, system leaders, and frontline teams. The complexity of organisations and of the geographical, operational, and political landscape in which they sit, has made integration far from straightforward.
The operational detail to integrate services must be developed locally. As the complexities and needs of local populations differ in each system there is no standard, ‘one size fits all’ solution. Much positive work has been done and many systems are developing innovative ways to deliver better, more joined up care, but there is still progress to be made.
As a means of focusing efforts and ensuring that work takes place at a scale where integration can have the greatest impact on service delivery, the importance of place has been strongly advocated in national policy. In many ICSs, the concept of place provides a tangible and practical scale for staff and leaders to design new services and models of care, enabling them to work together to deliver better outcomes for the local population – the very essence of integration.
AIMs of this programme
Throughout the policy changes of the last few years and particularly in the formalisation of ICSs in July 2022, much of the focus has been on issues of organisational structure. However, as important as this is, the drive towards integration is about delivering better care for people. Integration of systems on paper - but business as usual in terms of how things work - is not the aim.
The fundamental challenge for place-based partnerships is to ensure the delivery of better services, better care for people, and measurably improved outcomes. The process is one of reimagining and redesigning service delivery. In a complex organisational landscape this is a challenging ask. However, set against the backdrop of (among others) extreme workforce pressure and recovery from the pandemic, the challenge is even greater.
Engagement with individuals involved in the design and delivery of integrated care at a local level has shown that there is a genuine determination to mobilise these new partnerships and to move beyond ambition, through to delivery of improved outcomes.
There is no shortage of suggested models of integrated care and frameworks for transformation to support integration, including at place. There is less support available, however, on how to deliver integration on the ground, in practical, operational detail.
The aim of this work is therefore to provide a practical toolkit which draws together some critical components of an outcomes-driven approach to change; share local examples of integrated models of care; and articulates the reality of the operational frontline, complete with its current pressures and challenges. The toolkit is designed to stimulate reflection on current work and future plans, and to help leaders working at place to make progress in their unique contexts.
METHODOLOGY
Developing this toolkit has been a collaborative programme of work between NHS Providers and Newton, drawing heavily on the insights of NHS Providers’ members, Newton’s clients, and beyond.
In total, over 200 representatives from across the health and care sector have been engaged. In a range of capacities, these individuals have been involved in leading, designing, and delivering integrated care at place. The individuals were selected to ensure that a range of experience from across the country has been represented. This toolkit, an output of the joint programme of work, aims to reflect some of the breadth of views and insights colleagues have shared.
A number of systems and local partnerships have participated as ‘reference sites’, exploring and sharing their local experiences through workshops and interviews. This has typically led to a case study, which features in the toolkit. In a small number of case studies, patient stories are used. In these instances, names have been changed to protect confidentiality.
The programme has also drawn on a cross-sector steering group made up of senior NHS and local government leaders who have been instrumental in providing insight, constructive challenge and direction which has informed this toolkit.
Lastly, the toolkit has been created by drawing on Newton’s insight and experience gained from working alongside trusts, local authorities, and place-based partnerships to reimagine and redesign public services to improve outcomes for people, ways of working for staff, and financial sustainability. It has also drawn on NHS Providers’ experience of supporting trust boards to respond to national policy developments and the wider operational context.
The experiences of the following systems and local partnerships contributed to shaping the toolkit:
- Birmingham
(Birmingham and Solihull ICS)
- Bolton
(Greater Manchester ICS)
- Bradford District and Craven
(West Yorkshire ICS)
- Harrogate
(part of North Yorkshire) (Humber and North Yorkshire ICS)
- Lambeth
(South East London ICS)
- Mid and South Essex Integrated Care System
- Northamptonshire Integrated Care System
- North West Surrey
(Surrey Heartlands ICS)
NHS Providers and Newton would like to extend their thanks to all those involved in this programme of work for generously sharing their time, expertise, and support.
We hope that this publication will not be the end of the programme, but the beginning of a conversation. A series of events will be available to attend to explore the themes in greater detail and share experiences.
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