Cambridge and Peterborough ICS ABU Development

The Challenge

Tricordant was commissioned to support the ‘Most Capable Provider Steering Group,’ since renamed the Accountable Business Unit (ABU) Development Steering Group, through a ‘process consulting’ approach with an intended focus of helping to:

• Clarify the ‘why’ of the ABU creation and the associated benefits for patients, communities and staff.
• Support a focus on the core deliverable ‘whats’ of the ABUs.
• Enhance the ‘how’ of collaborative working required across the ICS, ABUs and partners.

4 ABUs are being developed in the system, 2 around ‘place’ and 2 around ‘key cohorts’ e.g. mental health /LDA and Children’s and maternity. The ABUs are also known as partnerships now. Each of the ABUs is hosted by one of the 4 local Foundation Trusts. Exploring the implications and dynamics associated with this has been a core part of our work.

Our Approach

A short diagnostic was undertaken with the ABUs and key stakeholders, which informed the design and delivery of a series of co-designed workshops for the ABU Development Steering Group and wider stakeholders.

Workshop 1 explored the ‘why’ of the ABU development and identified some key leadership shifts required to support the ABU development and the evolution of the overall ICS system.

• This informed a Memorandum of Understanding (MOU) developed between the ABUs and the ICB and an enhanced focus on real transformation and partnership, working in line with the ICS Leadership Compact.
• It also facilitated the ABUs working together as a group and with their host anchor organisations and other partners.

Workshop 2 considered the maturity framework for the ABUs including a ‘Gateway’ and associated OD Framework.

• The former focussed on the ABU ‘What’ that needed to be shaped and organised to serve delivery of the agreed transformational purpose (‘why’). Furthermore, supporting the assurance requirements associated with a Gateway process that is enabling preparation for delegation of increased decision-making and resources to the ABUs.

Workshop 3 explored accountabilities and responsibilities in the new system architecture.

• Identified lead roles and support roles for different ABUs, ICB functions and other partners.
• Tested this against a number of real-life examples.

Workshop 4 concentrated on the development of relationships and ways of working between the four accountable business units and the ICB functions.

• The workshop helped to clarify and share the purpose of each of the teams within the ICS.
• Working relationships were strengthened.
• Key challenges to how the new ICS architecture works were explored.

We ran an additional workshop for the newly formed Strategic Commissioning Business Unit of the ICB to support the development of their collective team working approach and ethos.

In addition to the workshops, we supported the steering group and key ICB staff in the overall development process. ABU development is now transitioning into business as usual within the ICS.

Results

Throughout the programme we have seen some key shifts in how the ABUs and ICB work together to accelerate the transformation and support operational delivery through a challenging period. The collective approach to working together has unleashed energy and momentum for change. This has included:-

• Keeping transformational change in population health and inequalities – and benefits for people and communities at the centre with a drive to prevention and early intervention, not ‘just’ redesign of existing services.
• Refocus from contracts and commissioning to communities and clinical voice.
• A shift from historic patters of interaction which might be characterised as ‘parent-child’ to more ‘adult-adult’ co- production where permission does not need to be continually sought as there is shared purpose, compelling priorities, agreed common values and ways of working.
• Recognising the move to more collaborative ways of working within and between ABUs – and across a broader range of partners – and away from the historic competitive environment of the NHS.

Learnings

As we have reflected together with system partners, our key insights include:-

• The development of ‘collective leadership’ at the systems level within and across ABUs creates the conditions for radical change.
• The value of learning by doing is enabled by collective reflection.
• Need to ensure any processes are co- produced, as simple as possible and aligned. This is congruent with the overall system shift sought. The processes used for change must be congruent with the outcomes sought.

The ABU programme has been a complex, multi-faceted and high impact piece of system working that has high gain/high risk opportunities. Tricordant’s support, insight and expertise have been invaluable in steering us through the work and being a critical friend to system partners. Whilst there is still much to do, we have made significant progress on our system leadership, shared ambitions and integration – this would not have been possible without Tricordant.

Kit Connick, Chief Officer Partnerships & Strategy

If you would like to learn more about this case study please contact alastair@tricordant.com