Integrated Care Systems – Finding hope, grounded in place.

In the final 1 minute read on the topic of new Integrated Care Systems developing across health and care in England, I want to focus on one of the key opportunities: enhancing place-based working.

The centrality of Place

Place-based partnerships are a key part of the new landscape with the greatest potential to make a real and fundamental difference to the health and well-being of individuals and society. NHS England and the Local Government Authority’s guidance to ICSs aims to create Thriving Places.

Improvement Scotland, in The Place Principle, offers a useful definition.

“Place is where people, location and resources combine to create a sense of identity and purpose and are at the heart of addressing the needs and realising the full potential of communities.”

Places, neighbourhoods, and communities are where people live, work, and relate. Communities are not defined by geography or organisations, but they are where organisations can reach out and connect with people in a meaningful way at the right scale. To do this well, organisations need to come together, work differently as partners, and connect with members of the community on targeted work programmes that have an impact.

If we get Place right, we have the potential to overcome disconnected services working in silos, competition between different organisations, fragmented workforce, and financial disincentives. The drive now is to deliver real change through agreeing improvement outcomes, mobilising assets differently, and working in partnership with communities to deliver real benefits. It provides opportunities to do real work that makes a real difference.

Guiding principles

Place-based working has long been a focus of local authorities, and indeed, in many parts of the country, they have worked closely with NHS and VCSE colleagues. Central government appears to be beginning to wake up to this concept but to fully grasp it in policy making. However, the levelling up challenge will surely need to have Place working at its heart if it is to be meaningful.

In thinking about how to support places, we suggest several principles that can guide and help design work.

• Clarify the why. By definition [as above], Place is a cohering concept requiring multiple partners, so as you will expect from us, being clear together about the purpose of any joint work is critical.
• Be clear about the level of system or Place that makes sense for the issue in hand. For, if you are looking at integrating health and social care teams, then it is neighbourhoods and PCNs [typically 30-50,000], but if it is acute hospital flows, it will be at Place [typically 250,000).
• Strengths-focused: bring an appreciative focus – what are the assets, networks, and resources we can work with?
• Collaborative: think formal & informal networks and movements, how do we build community connection and voice?
• Sustainable: what can we lean into? Where can we build on that’s already there?
• Strategic alignment with local practical impact: uses the wider system to set the strategic context for local action
• Design with diversity: build diversity from the system, representing diverse voices in any design process. The process you design to get you to the future will define your future; they are mutually reinforcing activities. So, we can’t plan for the engagement of people with lived experience without involving people with lived experience!

You can listen to a recent webinar we held exploring the topic of Flourishing Places; please click on the video below.

I hope this short series on Integrated Care Systems has given some useful food for thought as you think about your own complex systems. I’d love to hear your thoughts and experiences.