Integrated Care Boards (ICBs) have been tasked with reviewing and updating their Joint Forward Plans, setting out their priorities and how they will deliver care over the next five years. The challenge is not so much in writing or reviewing their plans, but in making them workable and achievable in the face of mounting pressures.
National priorities and objectives for the NHS continue to focus on recovering core service delivery and maximising productivity. Meanwhile, we are all aware of the significant challenges facing the service, including access to primary care, ambulance response times and elective care waiting lists, exacerbated by a limited workforce, financial pressures and strike action. Although system-based working is designed to address some of these challenges, it brings its own pressures as partners need to establish new ways of working together and shift towards more outcomes-focused activity. System partners must manage day to day organisational priorities alongside system-led direction, making best use of the skills and resources available to deliver more joined-up care.
Truly integrated planning requires organisations to combine a coordinated strategic approach with integrated operational delivery so that plans are grounded in reality and sufficient flexibility is built into the planning process to enable teams to adapt to changing demands. This means drawing together three layers of planning; the strategic-level Integrated Care Strategy which sets out what will be done, the Joint Forward Plan which describes how the strategy will be achieved, both supported by more detailed operational business plans setting the specifics of what will be done when, where and by whom. Drawing on our experience of delivering complex national programmes such as the COVID-19 vaccination programme, as well as system-level change projects such as demand and capacity planning, there are five key elements ICBs should consider in developing strategic and operational plans
1. Establishing a clear starting point
When assessing priorities and opportunities for change, start by building a clear picture across the system of what is already in place and what resources and skills are available. Notwithstanding some of the obstacles that may yet need to be addressed to enable fully integrated working, systems have an opportunity to bring together truly multidisciplinary teams, involving specialists across primary and secondary care as well as local authorities and the voluntary and community sector. How can these skills be combined to achieve more for patients? Although access to employee information is not universal across systems, NHS data is readily available through the Electronic Staff Record (ESR) and the national workforce Minimum Data Set (wMDS), and workforce data sharing with local authorities can and is being done to aid planning in some areas. This information, combined with details of related services, estates and other assets can provide a much richer starting point for planning, building in existing learning and reducing the risk of duplication.
2. Intelligence-led decision-making
Access to data and analytics has advanced significantly and continues to grow at pace across the NHS. From identifying priorities using population health management and risk stratification, through to modelling new pathways and monitoring impact via dashboards and other interactive tools, effective use of data provides the evidence to underpin a case for change, target resources efficiently and evaluate the impact of new initiatives. Integrated planning requires a single source of truth that gives system partners a transparent view of priorities, opportunities and impact to support decision-making at both a strategic and operational level. This intelligence has to be coupled with an understanding of the benefits and impact that need to be delivered as a result of the interventions. Creating an integrated measurement approach describing triple value and social value impact.
3. Connected outcomes and drivers of change
The most effective dynamic plans are those that connect the drivers of change to the outcomes being sought and consider this from a whole system perspective. In implementing a new pathway, for example, considerations should include the impact on wider services, such as A&E, diagnostics, outpatients and primary care and the equity of access and outcome for the population concerned. What skills and resources will be needed - both in effecting the change and in altering how this may impact wider teams? Will this impact how a system's workforce or estate is used, or the budget required? Are the right supply chains in place? This level of detailed impact assessment enables system leaders to fully understand, plan and implement the necessary activities to achieve the intended outcomes.
4. Effective engagement
Clinical engagement is essential in gaining a realistic understanding of the impact of activities - existing and new - and the opportunities for improvement. In delivering more integrated working, we need to build in joined-up, multidisciplinary engagement to fully understand some of the potential opportunities and barriers that need to be addressed. Alongside patient engagement, this input can inform the drivers for change, leading to more resilient plans. Moreover, ensuring staff and patients feel heard and appropriately engaged and supported through change can improve both staff retention and patient experience.
5. Clear, integrated governance
Underpinning strategic and operational plans should be clearly defined, multidisciplinary, connected governance to enable effective decision-making at every level across the system. ICSs need to work at scale and at pace, able to make confident decisions without unnecessary bureaucracy. There is a balance to strike, of course, and appropriate safeguards must be in place, but if we are to deliver change by drawing together multidisciplinary teams to work on joint projects across system partners, the governance and risk management needs to be equally integrated and clear.
Systems are facing similar challenges across the country. Although each place and system will have its own characteristics, there is much we can learn from each other. Drawing on best practice, building networks, such as the Integrated Resource Planning Network, and sharing both successes and failures will help the NHS fast-track improvements and eliminate unnecessary duplication. By developing integrated plans that connect the strategic with the operational, incorporating clear governance and evaluation, systems can not only achieve more using their collective resources, but also encourage more effective information sharing across England to support the NHS's national priorities.
This blog was originally written by Alison Tonge for Integrated Care Journal.
