Case study: Think about the whole system not individual service silos

Nicole Chavaudra

Programme Director, Bassetlaw Integrated Care Partnership

Bassetlaw’s Integrated Care Partnership

Working together across traditional sectoral divides is crucial at a time of financial constraint and increasing complexity. In Bassetlaw, our Integrated Care Partnership brings together a range of local partners, including a key role for our local voluntary and community sector. Together, we have embarked on a journey towards a new way of working together in a place. Along the way, we are delivering real health and wellbeing improvements for the people of Bassetlaw.

People’s wellbeing affects, and is affected by, almost every aspect of a person’s life, from housing, financial status and social capital, to the likelihood of experiencing life changing illness or early death. In recognition of the need to tackle the wider social and economic determinants of poor health and inequalities, public health functions transferred from the NHS to local government in 2013. However, the consequences of poor health are felt across the public and third sectors and beyond.

The potential for collaboration across sectors and silos to escalate progress in addressing these widest determinants of wellbeing and health at local level is recognised in Bassetlaw, a growing district of approximately 116,000 people in north Nottinghamshire. Bassetlaw’s Integrated Care Partnership (ICP) emerged in response. The aim of the Partnership is to deliver improvement in experiences, health and wellbeing for Bassetlaw citizens through simpler, integrated, responsive and well-understood services. By bringing together partners from across the local system, the Partnership has established the conditions for working together to enable different, better, more sustainable services in a time of financial constraint for all sectors. In Bassetlaw, this range of partners includes the voluntary and community sector, primary care, Healthwatch, local district and county councils, and three NHS organisations including two foundation trusts.

Critical to the effectiveness of the Partnership has been a shift away from traditional power paradigms across sectors. This has been characterised by provider organisations sitting below commissioners in the hierarchy of influence, with the voluntary and community sector situated several rungs below. The ICP Board is chaired impressively by the Director of Bassetlaw’s voluntary sector infrastructure organisation, who describes the third sector as having ‘parity of esteem’ with the public sector locally.

The Partnership Board secures the strategic commitment to collaboration, but the delivery of change and enabling of different, better and more sustainable services lies largely within the operational functions of partner organisations. The ICP’s delivery network acts as the engine room of change. Local officers and change managers of varying levels of seniority from across NHS, local government and third sector working together on shared priorities enables a small team to have a big impact. However, this is only possible with a strong local mandate. We have brought together a wide and diverse range of partners together to determine the priorities and followed where the energy lies. This has meant it has been possible to establish multiple work streams led by officers from across the sectors and hierarchies in a distributed leadership approach. As such, ownership and responsibility are simultaneously assigned to a lead partner and shared across the system.

Momentum has enabled progress as a result of the Partnership being both ‘on the balcony’ – taking a strategic view on long term need and action – and ‘on the dancefloor’ – immersed in the operational delivery and activity of services. Focus on the huge strategic change requirements is essential. In particular, we have centred on how partners work differently to tackle the causes of ill health to enable the shift of resources into prevention, rather than continue the trajectory of increasing costs of specialist services such as social care and hospital inpatient beds.

A sense of visceral change and progress requires smaller, shorter term initiatives and visible successes. Real projects that are able to deliver tangible outputs within six months are vital. For example, engagement with two local communities about the relationship between transport and wellbeing has enabled simple shifts in bus provision that can make a big difference. This had informed bids for transport info-kiosks to improve access to health and social connections within a few months, enabling people previously dependent on home visits by GPs to get the bus to their appointments. By comparison, planned shifts towards integrated planning, funding and delivery of community-based wellbeing services across NHS, local government and the third sector which recognises and builds on the knowledge and skills of community organisations, require time intensive relational and resource investment to bring to fruition.

There remain many challenges for the Bassetlaw Integrated Care Partnership.  Planning of services happens at many levels, and partners must work together to identify at which level certain types of provision are best planned. Whether this is at a system level, working across large populations; at a more local, neighbourhood level, such as via Bassetlaw’s three primary care networks which bring together primary care, community health and social care, the voluntary sector and beyond; or at a ‘place’ or district level.  Such decisions require sensitivity to local places, partnerships and assets. Financial challenges for all partners mean that there are limited resources for change management, so the capacity must come from within partners’ business as usual resources. However, the absence of plentiful resources to support change encourages creativity and enhanced commitment to get best value for the Bassetlaw pound through different, better local working.


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Principle 1
Think about the whole system not individual service silos
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