Introduction to leading and managing better care

Why integration is important

Health, social care and other public services are facing unprecedented demographic and financial pressures. In just 15 years’ time, the number of people over 65 is likely to have grown 50 per cent and the number of over-85s will have doubled. Demand is also growing from working-age people.

Current services are fragmented between health and social care, acute hospitals and primary and community services, and between physical health and mental health. They will increasingly fail to meet the needs and expectations of people who are living longer with a mixture of long-term health conditions and other needs that require joined-up, integrated care. The focus has to shift from treating illness to supporting people to stay healthy and independent for as long as possible. Integration is key to finding more effective and sustainable ways of achieving these goals.

The Department of Health and Social Care (DHSC) and partners within the National Collaboration for Integrated Care and Support agreed a definition of integrated care based on the National Voices narrative for person-centred coordinated care (2013).

My care

My care is planned with people who work together to understand me, and my carer(s) put me in control, and coordinate and deliver services to achieve my best outcomes.

Better Care Fund (BCF)

The Better Care Fund (BCF) was set up to drive integration between local authorities and the NHS and to pool resources to help achieve this. In 2017 it was expanded with additional money which was allocated directly to local authorities. The Better Care Fund is one part of a wider set of measures to achieve the closer integration of health and social care. Other activities include:

Tools and resources

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:

Integrating care is difficult

An important lesson from over 30 years of different policy initiatives is that achieving integrated care is hard to do. However, there are certain factors that can make the difference between success and failure. These have been identified consistently in national and international evidence and research over many years and have been used to develop the structure of this guide:

A key success factor is strong, shared and collaborative leadership, focused on outcomes that matter to people. Traditionally, senior managers have been expected to provide leadership within their own organisations, including the management of change programmes and internal communications. But integration requires change to happen across different sectors, organisations, professional disciplines and geographical boundaries. Leadership across the whole system is needed as well as leadership within each organisation.

This guide addresses both organisational and system leadership and how this can help make local integration plans a reality. It draws on research and from practice in places around the country. It is not a step-by-step instruction manual – developing leadership should always take account of different local needs and circumstances.

The guide should be complemented by a range of implementation support tools such as workshops and online learning. The checklists included in the guide focus on the most common areas and can be used as prompts to consider other models, tools and techniques.

I'm committed to ensuring that NHS England plays its part in shared system leadership… it’s not a few heroic individuals: it’s a different type of leadership and a more nuanced range of management skills and behaviours.

Simon Stevens, Chief Executive, NHS England at the King’s Fund Annual Leadership Summit, November 2014

How do you develop system leaders who see beyond the boundaries of their organisations? I think you have to do it in many ways. My senior leaders and my colleagues in other organisations have to develop a critical mass of people who believe in it, and behave it. Not all of them feel the same because they have so much going on in their own organisations that they cannot see beyond that. But when we do, we need to give people the tools and have a performance management system that requires collaborative working. So we have just put in a big learning and development programme, at the heart of which is building confidence and competency about outward-facing collaboration in our staff.

Joanna Killian, Chief Executive, Surrey County Council

Case studies

Checklist – integrating care at scale and pace

There is no single best way of integrating services but evidence and experience offer some important lessons.

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Source of checklist: Making integrated care happen at scale and at pace, The King’s Fund (2013)

How to lead and manage better care integration guide
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