Delivering integrated care

Overall arrangements

Effective programme management and governance is crucial in translating the local vision for integrated care into a practical plan that delivers discernible improvements and better outcomes for individuals and the local population.

Good governance should offer structured programme oversight that brings together all relevant organisations in a focused, collaborative way to support the shared vision for integrated care and how this will be achieved.

Local areas have considerable flexibility in how they implement integration, but there are several national initiatives that contribute to this goal. Programme management and governance arrangements should therefore show how each programme contributes to the overall delivery of integrated care for individuals and the local population. As a minimum:

• national reporting and assurance process requirements for each national programme should be complied with
• ensure that there is clear strategic alignment between integration-related plans - including the STP/ICS plan for implementation of the NHS long Term Plan, BCF Plan and Joint Strategic Needs Assessment
• the development of new care models should be an integral part of the local vision for integrated care, not a separate add-on
• the opportunities for individuals to integrate their own care through local integrated personal commissioning programmes, although on a smaller scale, should not be overlooked

Areas should benchmark themselves against the Stepping up to the place: integration self-assessment tool to identify the strength of local leadership and maturity of health and social care integration in their area.

Programme management

The role of the programme management officer should focus on achievement rather than activity for its own sake, ensuring the programme board has the concise and focused information it needs to understand progress against schedule and budgets, and to recognise and manage the risks and issues that could limit progress.

Good programme management is about understanding and contributing to a vision and then building and organising a committed, skilled team to deliver specific objectives that will realise that vision. A well-managed programme will have a constant dialogue with system leadership over its objectives, priorities and progress. There will be difficult decisions to be made over priorities, and trade-offs will have to be conducted between time, cost, scope and quality. Issues will crop up with disaffected stakeholders or around funding availability. Risks around information availability or financial incentives will have to be actively managed.

All this requires a senior and experienced individual who understands the programme vision and plays an active role in shaping the programme to deliver that vision. This person needs to be credible among managerial and clinical leaders from across the system, able to quickly build a good knowledge of the main content issues, and to understand the difference between administrating and managing a programme. The programme manager understands and shapes the content of the programme rather than being a mere administrator of the plan. They have a meaningful dialogue with stakeholders in shaping the programme, actively build a team that can deliver the programme, and work closely with the communications lead to craft and deliver the story of the programme.

Achieving a shared purpose and clear vision has been key to getting so many people involved in so many sectors. Achieving this has taken time, with many iterations of the vision and challenges of “we do this already” and “it will never work”, but the time invested in this has led to a greater clarity and commitment.
 
The thorough way we approached planning at the beginning is now starting to result in benefits. Because our programme was an iterative process based on testing things and learning from them, without a solid framework, we would have struggled to keep on track.

The Local Vision programme in South Tyneside describes what effective programme management has meant.

Checklist: programme change

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Case studies

• Governance – North West London (NWL) Open

  The NWL Whole System Integrated Care programme has incorporated ‘lay partners’ (people who use services and carers from across the population in NWL) into every layer of its programme governance structure to ensure co-production is embedded throughout.

  The cornerstone of the co-design process was the set of working groups that were held across five modules to address the central questions of integrated care design for North West London.

  A working group was established for each module which consisted of an equal partnership between lay partners, clinicians, commissioners and care professionals to co-design the future of integrated care. Throughout this programme, the focus was on the importance of incorporating both the professional expertise of the clinicians and care professionals and the holistic lived experiences of the lay partners. There was lay partner representation on each one of the module working groups, and everyone worked as equal partners throughout the programme.

  Programme governance structure (co-design phase)

  • North West London Integration Board
  • Programme Board
  • Embedded partnerships
    • WSIC Lay Partners Forum (Lay partner representation)
    • WSIC Lay Partners Advisory Group (Lay partner representation)
    • Population and Outcomes working group (Lay partner representation)
    • GP Networks working group (Lay partner representation)
    • Provider Networks working group (Lay partner representation)
    • Commissioning and Finance working group (Lay partner representation)
    • Information working group (Lay partner representation)
  • Co-design sessions
    • Communications and PMO
    • Programme Executive Group
    • Programme Team
    • Points of contact

  Reproduced from
  North West London Whole systems integrated care toolkit

• Strategic commissioning in Northumberland Open

  In Northumberland, health and social care commissioners are planning to develop a more strategic approach to commissioning. Under the new governance arrangements, the health and wellbeing board will continue to oversee public health and social care commissioning and the wider system. Meanwhile, the CCG board will continue to oversee and make final decisions on health funding and will monitor system performance.

  A new joint commissioning unit will support both these boards and oversee the accountable care organisation, which is likely to be a partnership between Northumbria Healthcare NHS Foundation Trust (the acute, community and adult social care provider), Northumberland, Tyne and Wear NHS Foundation Trust (a mental health provider) and general practice.

  The unit is expected to maximise opportunities for joint planning across public health, health and social care, and to make best use of much smaller commissioning teams. Under the proposals, commissioners will focus on a narrow range of more strategic issues. These include: setting the high-level outcomes it expects the accountable care organisation to achieve; allocating funding to the accountable care organisation and to a small number of separate services; monitoring outcomes and performance, and intervening where there are significant concerns about performance; overseeing public engagement; and, in some cases, making final decisions on major service change.

  Meanwhile, commissioners envisage transferring almost all of the annual £400 million budget for core services to the accountable care organisation, which will be a partnership of its acute, mental health, community services and primary care providers. Northumbria Healthcare is likely to formally hold the contract for managing the health budget. However, the intention is for the other providers to work in partnership to manage the budget and manage risks.

  Finally, the CCG intends to transfer staff to the provider system to carry out a range of more tactical activities, including developing the contracts and overseeing the performance of individual services.

  Source: New care models: Emerging innovations in governance and organisational form, The King’s Fund (2016)

• Connected care programme in Berkshire West and Frimley Open

  Building on work initiated by the local CCGs, Berkshire West ICS and Frimley ICS have been working together to improve information-sharing across primary, acute, mental health, community and social care services. The programme brings together records from across the organisations involved – 18 health and social care organisations and 135 GP practices – into a shared care record, giving health and care professionals instant access to information about their patients drawn from across the system. It is supported by an IT system that collects and makes accessible information from the range of IT systems used.

  The system went live in January 2018. A website has been created to inform patients and the public about how their information is being managed and how they can express their preferences in relation to information-sharing, and there are a range of materials on the programme available from the organisations involved. The budget is £10.8 million over five years, and is drawn from a range of sources, including £600,000 from the Better Care Fund. The longer-term ambition includes improving patients’ access to their information through a portal, and enhanced population health analytics capability, to support priority-setting and targeted support.

  Source: Digital change in health and social care, The King’s Fund (2018)

Tools and resources

As detailed earlier, Shifting the centre of gravity (LGA, NHS Confederation, ADASS, NHS Clinical Commissioners), NHS Providers and ADPH is a self-assessment tool designed to support local health and care leaders to critically self-assess their ambitions and capacity to deliver integrated care. This includes the basic elements of good programme management.

The Integration resource library (Local Government Association) signposts local areas to evidence, case studies, tools and resources which will support the development of integration ambitions locally.

Making an impact through good governance: A practical guide for health and wellbeing boards (Local Government Association) discusses the contribution of health and wellbeing boards to the local delivery of integrated care and includes examples and case studies.

Managing organisational change in adult social care (SCIE) is an online resource to support managers in care services, local authorities and integrated health and social care services. It explores managing change through case studies of managers in different settings.