A health/care system chief executive recently told me something interesting. It came when colleagues and I from the Social Care Institute for Excellence (SCIE) were providing tailored support to those localities where Care Quality Commission (CQC) local system reviews had been completed. That chief executive concluded that now, for the first time, she and her colleagues had 'a credible, robust and independent' basis to develop a better working system.
The CQC reviews took place in twenty areas where delayed transfers of care and associated metrics had indicated potential for improved arrangements. We helped prepare for and run summits where the CQC findings were presented and discussed, and then we acted as a critical friend to some areas during the production of action plans.
The CQC reviews took place in twenty areas where delayed transfers of care and associated metrics had indicated potential for improved arrangements. We helped prepare for and run summits where the CQC findings were presented and discussed, and then we acted as a critical friend to some areas during the production of action plans.
Chief executive
The experience reminded me of my time as director of adults services in Liverpool where I had great relationships with my counterpart in the clinical commissioning group. However, when our system experienced problems, the truth is that we couldn't always distinguish between symptoms and root causes, so weren't sure where to focus our improvement effort.
Lessons learnt
So what did we at SCIE discover about how leaders put in place sustainable cross-system improvement plans? Firstly, as one our senior consultants put it: 'Leaders at the summit recognised that whatever the quality of the plan they had to be sure they had the capacity, capability and commitment to deliver it'. Wise words - we all know of too many cases in which implementation of plans has floundered because of inadequately-resourced delivery or a loss of focus amid competing demands for time and energy.
Secondly, many areas in the reviews showed determination to build shared momentum around improvement by identifying quick wins. These could then become a platform for addressing more deep-rooted and complex areas, most commonly around workforce planning and development, and market capacity.
Finally, but importantly, several areas recognised that a hallmark of real sustainable improvement is the greater involvement of experts-by-experience as well as wider citizens. Applying co-production principles can help keep the focus where it needs to be and away from introverted organisational approaches. As a thoughtful member of SCIE's co-production network told me: 'Services only exist because people use them – so they need to be built around those people, not the other way round'.
Several areas recognised that a hallmark of real sustainable improvement is the greater involvement of experts-by-experience as well as wider citizens.
Chief executive
It's been an eye-opener engaging in this work. It's quite humbling to reflect that health and social care structures are ultimately an accident of history. However much we know this to be intuitively true, the clear message emerges yet again that no one single agency, profession or discipline has all the answers. Using the insights, perspectives and advice of those experiencing health and care services, is the key to getting us get beyond traditional boundaries and focusing on what matters: improving people's experiences and outcomes.
Using the insights, perspectives and advice of those experiencing health and care services, is the key to getting us get beyond traditional boundaries and focusing on what matters: improving people's experiences and outcomes.
Chief executive
Five key lessons from supporting CQC system reviews:
Any area developing plans to tackle the interface between health and care should:
- Engage all local partners in planning, including people who use services and carers, the voluntary, independent and community sectors
- Clarify, and where necessary, create or strengthen governance arrangements to ensure ownership and delivery of action plans are clear
- Align plans with existing programmes
- Balance short-term fixes with longer-term, sustainable improvements
Consider the use of external facilitators to challenge and support planning.
SCIE: Lessons learned from Local Systems Reviews Support Programme – Includes a vlog from Tony on the issue
SCIE: Leadership in integrated care systems
SCIE: Delivering integrated care: the role of the multidisciplinary team
About the author
