Establishing a Clinical and Care Directorate within Lincolnshire Integrated Care System

Lincolnshire Integrated Care Systems (ICS) wanted to enable and facilitate effective clinical leadership following its legal establishment in July 2022. Arden & GEM’s clinical support team was tasked with supporting this ambition by working in partnership with the Medical Director and Director of Nursing to develop a new Clinical and Care Directorate.

Following an eight-month period of project support, Lincolnshire ICS now has an established Clinical and Care Directorate with a shared vision, appropriate structure, supporting team and effective governance processes in place.

The challenge

As part of the arrangements for legally establishing ICSs in July 2022, NHS England guidance ‘Building strong integrated care system everywhere’ placed a focus on creating local frameworks and development plans for clinical and care professional leadership.

To achieve this within Lincolnshire ICS, a proposal was supported by the System Leaders Board (SLB) to establish a Clinical and Care Directorate. The purpose of the Clinical and Care Directorate was to enable and facilitate a shared vision for effective clinical leadership in the new ICS.

NHS Lincolnshire ICB tasked Arden & GEM’s clinical support team with supporting the development of a new directorate which would:

• ensure clinical leaders across the system were involved in all stages of decision-making for service redesign and pathway development
• play a key role in the sharing of knowledge and understanding across the system, acting as a conduit for clinical engagement and improvement activity.
  
  

Our approach

Arden & GEM assigned a clinical lead nurse to manage the project, who not only had direct experience of clinical leadership but also had expertise in clinical and corporate governance and building strong professional relationships teams.

Delivering the vision
ICS stakeholders and partners agreed a shared vision for the Clinical and Care Directorate of improving outcomes and tackling inequalities by ensuring pathway and service development is evidence-based and meets public health needs. To achieve this vision, the project team identified a series of key tasks:

• bringing together appropriate expertise
• putting the right supporting resources in place
• developing an academy that could identify, share and assimilate best practice and research.
  
  

Implementing governance processes
In order to remain transparent and open to scrutiny from peers, patients and the public, a directorate governance structure was embedded. This included a Strategic Board which brought together representatives from general practice, the PCN, pharmacy, dentistry, social care, public health, allied health professionals and the Local Medical Council with nursing and medical directors. Collectively, they are responsible for providing assurance on all new clinical developments and the system’s clinical strategy.

With Arden & GEM’s support, the Board brought together the right people in regular structured and recorded meetings with agreed Terms of Reference and empowering mechanisms for reaching consensus.

An NHS Futures workspace was established as a repository for all directorate documentation as well as a platform for system stakeholders to find out more information about the directorate and its purpose.

Recruiting a substantive team
Three posts had been identified as critical to the ongoing success of the new directorate, in delivery, data and quality improvement. Recruitment processes were undertaken and line management duties fulfilled until the team was established and effectively supporting the directorate’s aims.

Establishing an academy of clinical excellence and learning network
Under the Clinical and Care Directorate umbrella, there was also a Lincolnshire Academy of Clinical Excellence (LACE) which decided what transformation work needed to be delivered and commissioned work to be undertaken by a learning network. The Lincolnshire Learning Network (LLN) was developed, and this forum became the source of improvement expertise across the system. The vision for both was a patient centred, system-based resource, led by clinicians and care professionals, to achieve the best outcomes for the population of Lincolnshire.

In support of its research focus, a partnership agreement was put in place with the University of Lincoln with agreed priorities for 2022/23. Links were also forged with existing professional networks such as the Local Pharmaceutical Committee (LPC) and Allied Health Professional (AHP) Council.

Outcomes

Following an eight-month period of project support, Lincolnshire ICS now has an established Clinical and Care Directorate with a shared vision, appropriate structure, supporting team and effective embedded governance processes in place.

Through successful formation and development of the Clinical and Care Directorate, there is now:

• A shared vision for the delivery of improved health outcomes for the local population
• Clinically led strategic delivery planning
• Clinical leadership and ownership of the System Development Plan
• Clinical leadership and ownership of the development plan for clinical and care professional leadership
• Shared understanding and knowledge relating to system-wide improvement activity and pathway development.

The directorate has already identified two care areas for transformation focus: frailty and colorectal cancer. A system-wide frailty strategy has been developed, with the support of Arden & GEM’s clinical lead nurse, to deliver better and safer care for the population of Lincolnshire using qualitative and quantitative data.

 Find out more about our Clinical Redesign service please follow this link.