Integrating Adult Social Care and Health: Lessons Shared, Lessons Learned

Integration Report: Download 


We’d like to thank everyone for attending this session, both for their time but more importantly their insight and willingness to fully engage throughout the day. Our special thanks goes to our speakers, Cheryl, Tom, Jane and Hellen, who for us epitomise the system thinking that is required to support and drive integrated ways of working. This was probably our most heavyweight workshop to date and everyone left tired but with the benefit of a lot of wisdom and some proposed approaches for a range of complex problems.

This document summarises the discussions in terms of identified challenges and proposed solutions under the following headings:

  • What are the Key Challenges to Integration
  • Challenges for Vanguard
  • Addressing the Challenges
  • Support to Address the Challenges

What are the Key Challenges to Integration

There were a number of recurring themes that emerged around the difficulties of driving and managing integration:

  • Convincing people to make investment or change the way of doing things, even if there was little evidence to support it
  • There is a need to have mechanisms in place to demonstrate cause and effect (both micro and macro)
  • There are so many stakeholders with what appear to be, on the surface, different opinions and drivers
  • Solutions that have been implemented have had a poor take up from operational staff
  • Developing solutions, such as the approach for an integrated care record, has been difficult to achieve
  • Getting data and access to data and understanding what it demonstrates
  • How to prevent programmes stalling and then restarting again under a different badge
  • The patient or service user is very often left out of the conversation and thus omitted from the design of solutions
  • Involving the voluntary sector is difficult because of competing drivers and the regular turnover of volunteer staff
  • Very difficult to get GPs to buy into community interest approach
  • How do we genuinely drive a community or bottom up approach

Challenges for Vanguard

In addition, there were some particular challenges faced by the Vanguard areas and while their challenges reflected much of the discussion, there were some specific pitfalls:

  • Lack of clarity about the collection and use of performance management data
  • Lack of clarity about the collection and analysis of service user/patient level outcomes
  • Lack of clarity around the lines of accountability and responsibility
  • The aims, objectives, governance and management processes are not fully communicated to middle-management nor across partner organisations
  • Information sharing issues
  • There is a need for a workforce strategy to address systemic issues of recruitment, retention, training and skills across the workforce
  • A need for a clear risk stratification approach
  • The need for structured and managed involvement of the VCS particularly in terms of self-management, early intervention and prevention

Addressing the Challenges

It is recognised and was acknowledged that integration is genuinely difficult and it will take time and energy to deliver what may seem like the smallest gains. In this section, we have summarised these key themes and supplemented with the specific findings from the Vanguard evaluation learning. We thought the Alcove approach epitomised a bottom up, data driven approach to change, with a financial benefit – it’s worth exploring further. We’ve attached Hellen’s details and a link to the website.

There were 6 key areas that need to be addressed to enable effective integration:

  • Relationships
  • Governance
  • Measurement
  • Programme Management
  • Building Credibility
  • Design
  • Form deep relationships across the system
  • Understand organisations’ and individuals’ different pressures and perspectives
  • Rigorously engage with stakeholders, including politicians – this is mainly done outside of formal governance
  • The time taken to engage should be planned, accounted for and made clear through the governance
  • Behave collaboratively at a leadership level
  • Put the structures in place so leaders can behave collaboratively
  • Think about creating independence by seating the programme in the right place in the overall system governance
  • Governance is about making good and timely decisions, not how many boards you have
  • Produce an easily digestible dashboard that is reported monthly
  • Apply rigour and governance, especially where evidence doesn’t exist
  • Clarify as early as possible in the process what it is you want to measure and what you want to change in the end
Programme Management
  • Co-develop a blueprint for change (business case)
  • Effective resource planning to support and allow people to do what is expected of them
  • Change is continual have the structure and rigour in place to drive this
  • Build patients, services users, staff and politicians into the design of new ways of working
  • The reasons why the Vanguards are working is that they’ve invested in programme management which give them energy and focus
  • Plan, schedule and manage the implementation of the changes
  • Ensure that the programme has mechanisms in place that to allow you to learn and adapt quickly
 Building Credibility
  • Create the conditions for success, through partnerships and relationships, involve experts and staff and ensure there is capacity, plan to scale and scale when the conditions are right
  • Recognise that one size does not fit all – communities are different and these are Patient-centred models
  • Use a Logic model and develop a Value proposition
  • Design and document each of specific component of the care redesign, including commissioning and contracting
  • Spend effort and be clear from the outset about information sharing
  • Understand and document business requirements before investing in any Information system

Support to Address the Challenges

The team in 4OC have spent over 20 years delivering successful change programmes that have required a high degree of collaboration across organisational and budgetary divides. The themes referenced above highlight two things that underpin our approach:

  • Rigour
  • Structured Management to allow for good and timely decision making

Running programmes of this nature can be costly and we have seen many that don’t deliver, resulting in huge levels of frustration in leaders and staff alike. Setting the programme up correctly is key to making them a success and the effort involved in this is often overlooked and almost always underinvested.

We provide the following types of support:

Developing a Blueprint for Change
  • Cements commitment to a vision
  • Addresses concerns around organisational as well as system pressures
  • Fully engages senior stakeholders in the design
  • Aligns accountabilities and responsibilities
  • Outlines the activities and resources required to make the change
  • Outlines the key decisions, impact and risks that will need to be managed over the lifetime of the programme
  • Works along side existing teams to co-design and drive ownership of change
  • Provides a robust framework for managing the programme on an ongoing basis
  • Helps define the measures and the measurement mechanisms (financial and outcome)
Programme Management Support
  • Adds short to medium term capacity and building confidence, credibility and capability
  • Drives the rigour into programme management and reporting
  • Ensures good and timely decisions are made
  • Allows the impact of change to be understood and managed in a controlled way
  • Provides the tools and methods which allows you to become self sufficient
Programme Review/Assurance
  • A rapid independent assessment of the mechanisms in place to manage a successful programme
  • An assessment of the likelihood of the programme delivering its outcomes
  • An assessment of the organisational readiness for change, including its digital maturity

Well, that’s it. Congratulations if you’ve got this far! You can download a copy of this report at the top of the page if you want to share the wisdom with your colleagues. If you’d like to get in contact to discuss anything you’ve read, you can call the office on 0207 9283127 or send us an enquiry here.


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