Assessing Integration using the SCIE logic model
Essex County Council
The SCIE logic model for integrated care provides a visual depiction of how a fully integrated health and care system might be structured and function, and the outcomes and benefits it should deliver for those who use
services and their carers.
Using the SCIE logic model and assessing each of its four localities in the same way, Essex achieved both a local and a strategic view of how integration was happening across the county, as well as a baseline against which future progress could be measured.
‘We were looking for something that could give us an indicative view of what good might look like, some of the key functions and how it could link to outcomes and benefits. We knew that it would not be a blueprint for the integration
programme in Essex, but would help with consistency and to help with baselining and planning. The SCIE logic model provided us with a framework to work with representatives from across the health and adult social care system(s) in Essex to both assess how confident we were that we had spent enough time investing in the right enablers to make integration in Essex successful, and how far along we were with the components of integration.
The model allowed us to be really “local” in our assessment which appealed to the system(s) we work within. It was able to be dependent on the aspirations of the individual localities, but by applying the same criteria we have been able to assess each locality on the same basis. It helped to create a level of consistency across Essex.’
Emma Richardson, Head of Integration and Partnerships
Essex County Council
The assessment was carried out in 2018. There will be another assessment in 2019 to help Essex understand the successes and challenges they have faced over the last year.
- Essex County Council has a team dedicated to integration with ‘partnership leads’ linked to each clinical commissioning group (CCG) and countywide under a head of integration and partnership.
- Individual areas completed a self-assessment using the SCIE logic model, identifying enablers of integration and components of integration given a ‘rag’ status (red-amber-green).
- The team then gathered to ensure consistency had been applied using the criteria. Rolled up into a countywide view, this was communicated with senior leaders.
- By having a dedicated team, no governance was required as it has been used primarily as a self-assessment and planning tool.
Essex identified a number of challenges to assessing progress with integration.
- Significant demographic differences between localities.
- Local issues vs countywide issues.
- Regional structure – in Essex there are five CCGs, three sustainability and transformation plans (STPs) and two unitary authorities. Because of the number of organisations, as well as cross-local authority boundary STPs there are plenty of opportunities for inconsistency.
- Increased demand and forecasted pressures.
- Falling budgets.
- Change in complex systems is constant and ‘integration’ is not always a tangible thing. Trying to measure the impact of it is therefore very difficult – integration is often a behaviour and mindset which is difficult to measure.
The assessment for Essex in 2018 was red/amber. The authority has been able to indicate the level of progress they would like to achieve over the next 12 months and to focus resources on accomplishing their goals.
Example of summarised assessment of one locality – South Essex.
Utilising Better Care Fund (BCF) and Improved Better Care Fund (iBCF) resources to increase integration across the quadrant has begun
to make a difference, but this is 'fixed term' and outcomes need to be achieved while people are in post. Multidisciplinary neighbourhood teams are in place across all nine localities and fortnightly meetings allow agencies to refer those individuals identified as having growing health and care needs.