Achieving integrated care: 15 best practice actions
Published: November 2019
The Local Government Association (LGA) and the Social Care Institute for Excellence (SCIE) have joined to produce an accessible and practical resource that supports local systems in fulfilling their ambition of integration. From experience working with local systems, we know that the journey towards integrated care takes time, energy and resources from all local partners. Change can be slow, with setbacks common, but there are a handful of actions local leaders can take to accelerate progress.
The 15 actions prioritised in this resource draw on evidence about what works from international research, emerging best practices and engagement with our own stakeholders and partners. The actions are deliberately aligned with national policy, legal frameworks and regulatory guidance, but most importantly, they allow for local variety in system design and service delivery to flourish. Although voluntary, they also complement the existing tool, the High impact change model.
We envisage a ‘whole system’ approach in taking these actions forward, involving system leaders, health and social care commissioners and providers, frontline professionals, local communities and local people. By applying these actions, local partners will be able to focus on three key elements:
- delivering person-centred coordinated care – i.e. the core objective of integrated care
- building local ‘place-based’ care and support systems
- system leadership for integration
For each action, the resource sets out the rationale, ‘How to’ tips, and signposts to the underpinning evidence and examples of good practice.
The principles underpinning the actions
A number of core principles underpin the 15 actions. First, integration is not the end goal in and of itself. Instead, it is a means towards achieving the goal of better, joined up care. Integration creates opportunities for transforming people’s experiences of care from disjointed to coordinated, reactive to proactive, and service-orientated to personalised. Effective integration should enable people to live healthy and independent lives. Care planning and coordination should build on an individual’s strengths and preferences. We have adopted some of the ‘I/We’ statements from Think Local Act Personal’s ‘Making it real’ framework. This will further highlight the way in which a particular action relates to the expected outcomes for both people who use (‘I’ statements) and people who provide (‘we’ statements) a service.
Integration should also support the building of community capacity for prevention, early intervention and ‘place-based’ care and support. ‘Place’ is an integral aspect of the best practice actions, but we recognised that the concept of place will mean different things in different contexts. Therefore, we suggest ‘place’ be defined by local partners and used flexibly to accommodate a range of geographic footprints and population sizes. For example, in some instances, place may mean as small as a neighbourhood; in others it will reflect the political boundaries of a local authority; and in some instances place will be defined as regional.
The principle for defining place should be one that optimises collaboration between local partners – and where there is a clear purpose for working and across organisational or institutional boundaries.
Finally, this resource is designed to support improvement and not performance management. Our consolidation of key sector research and best practice examples is intended to help local systems identify areas for improvement and introduce sound approaches for accelerating progress or tackling the barriers to better care. In particular, the resource draws on:
15 best practice actions
Realising person-centred coordinated care
- Risk stratification: Identify the people in your area that are most likely to benefit from integrated care and proactive support, and preventative support.
- Access to information: Ensure individuals and their carers have easy and ready access to information about local services and community assets. Also that they are supported to navigate these options and to make informed decisions about their care.
- Multidisciplinary team training: Invest in the development and joint training of multidisciplinary teams (MDTs) to transform their skills, cultures and ways of working.
- Personalised care plans: Develop personalised care plans together with the people using services, their family and carers.
- Rapid response: Provide access to integrated rapid response services for urgent health and social care needs through a single point.
Building place-based care and support systems
- Operational framework: Create an integrated care operational framework that is right for the local area, and which aligns service delivery and service changes to a clear set of benefits for local people.
- Integrated commissioning: Use integrated commissioning to enable ready access to joined-up health and social care resources and transform care.
- Shared records: Identify and tackle barriers to sharing digital care records to ensure providers and practitioners have ready access to the information they need.
- Community capacity: Build capacity for integrated community-based health, social care and mental health services, focusing on care closer to home.
- Partnership with voluntary, community and social enterprise (VCSE) sector: Foster partnerships to develop community assets to provide easy access to a wide range of support.
Leading for integration
- Common purpose: Agree a common purpose and a shared vision for integration, including setting clear goals and outcomes.
- Collaborative culture: Foster a collaborative culture across health, social care and wider partners.
- Resource allocation: Maintain a cross-sector agreement about the resources available for delivering the model of care, including community assets.
- Accountability: Provide system governance and assure system accountability.
- Workforce planning: Lead system-wide workforce planning to support delivery of integrated care.
SCIE acts as an improvement partner to local areas and systems across both children’s and adults’ services.
We provide a combination of capacity, expertise, knowledge, support and challenge as local areas reconfigure their care services and systems.
We work with the whole system including local authorities, clinical commissioning groups, care and health providers, user-led organisations, local citizens, voluntary, community and social enterprises – to develop and deliver improvement plans.