News and Comment

Making change happen: Lessons from OPM’s evaluation of AQuA’s Integrated Care Communities Programme

Monday 31 March 2014

Integrated care is the initiative on everyone’s mind. Currently, NHS England is busy scrutinising applications from localities to access the £3.8 billion Better Care Fund. In order to be successful these plans will have to show how they will make integrated care a reality in their local area.  This is of course no easy task. It will require partners to work together more effectively in a climate of increasing financial constraint and growing service demands.

But what does it actually take to make change happen – to create truly integrated care?

For the past 12 months, OPM has been evaluating the Advancing Quality Alliance’s (AQuA’s) Integrated Care Communities Programme. We’ve worked with the 12 participating health and social care economies across the North West of England, to generate learning regarding ‘what works’ in developing and implementing integrated care.

Our evaluation of AQuA’s Integrated Care Communities Programme shows that there is no ‘one size fits all’ approach to making these changes, and prioritising the local context is crucial to the success of any programme.

From the evaluation, we identified a handful of key lessons for those charged with leading integrated care:

Leadership

  • It sounds obvious, but strong, engaged leaders who set out and truly believe in the vision really are vital. Clinical leaders can also play a key role in developing plans for integrated care. They understand how the system currently works, see and hear first-hand how service users experience current provision, and can communicate messages to their peers. We suggest engaging some clinical champions at the outset, and really using their insights to inform the integrated care model.
  • Don’t forget the leadership provided by your local project manager – having a dedicated post-holder with time to commit to taking the work forward, as well as the skills and experience needed, is vital. Tagging integrated care development onto someone’s existing job is not likely to be a recipe for success, however difficult a dedicated post might prove to resource in the short-term.

Governance

  • Having effective governance arrangements within each key partner organisation, as well as across the partnership as a whole, is vital for success. Partners need to have confidence that what’s been promised will be delivered. It’s also important that there are named, accountable managers in key partner organisations: we’ve seen successful examples where there are named leads in the CCG, local authority, community care provider and the local acute trust.
  • Ensure there is clarity regarding reporting arrangements and decision making processes. Again, it sounds obvious, but if these aren’t agreed in writing and adhered to, progress is likely to stall. Having an operations group, supported by short-term task and finish groups and reporting up to the board, has proved very effective in sustaining progress in some of the economies.

Service user and carer engagement

  • There is an important distinction between service user engagement, consultation, and co-production. However, the terms are often used inter-changeably. We suggest careful consideration at the outset about how you want to engage service users and carers; what do you hope to achieve, how can they add value to the process? To truly co-produce an integrated care approach requires ongoing involvement from the outset, to inform, shape and test out the model of care. It might not be possible to co-produce the model with all harder to reach groups and communities, and so ongoing engagement activities with these groups should also be built in to plans.
  • Our evaluation has highlighted that many economies have taken steps to engage service users in the development of their integrated care plans, including testing out tools such as websites and leaflets, giving their views on what currently works well or less well, and helping to shape the vision. However, we’ve seen far less evidence of carers being engaged in these processes. It’s important that the voice of carers – who may be representing some of the most vulnerable service users – is not lost.

Service re-design

  • Integrated care models can be developed at team, service or system level. Learning from our evaluation indicates that team level integration may prove easier to realise, but system level integration is likely to offer the greatest potential benefits for service users, commissioners and providers. It is important to be clear about the level of integration being sought, and consider how team or service integration may form vital components of larger scale system integration.
  • Our evaluation has highlighted some effective reflective learning processes being used by local health and social care partners. For example, one economy successfully holds regular review meetings involving representative from all the MDTs, using the PDSA cycle to reflect on learning emerging and rolling out good practice across their locality.

In addition to the issues outlined above, it is also vital to consider organisational culture and workforce issues, financial arrangements across the partners (and any associated economic impacts expected from the integrated care model) and contractual mechanisms in place between commissioners and providers.

There are no quick fix solutions to developing an effective integrated care approach. However, evidence from our evaluation indicates that exploring these issues in depth during the early stages of planning your model will enable you to mitigate some of the potential risks and challenges further down the line.

OPM’s evaluation of AQuA’s Integrated Care Communities Programme runs until April 2014 and the full evaluation report will be published on the OPM website.