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:

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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Objectives and rationale

Prioritisation and resourcing

Structuring the programme

Managing the plan, reporting issues and risks


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Case studies

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.

How to lead and manage better care integration guide
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