This research looks at the characteristics of an effective system and the reasons why some systems are thought to be effective.
We commissioned RSM UK Consulting LLP to carry out this research and write the summary and full report.
Purpose of this research
This research aims to describe the characteristics of an effective system and the reasons why some systems are thought to be effective. By reviewing the literature, this report can explain what works and gaps in what is currently known about effective systems.
Background and introduction
CQC have been given new powers to regulate and inspect Integrated Care Systems (ICSs). ICSs bring together local authorities, NHS organisations and the voluntary and community sector. ICSs can take a view of the health and care needs of everyone in a particular area. This can help them to provide high quality care and reduce health inequalities. CQC are changing the way that they assess health and care organisations. This will ensure that the ways in which systems work are included in CQCs assessments.
Findings from the literature review
Theme 1: Key features and characteristics of effective, well-performing health and care systems
- Bringing together different partners to work collaboratively together. These include the Voluntary Community and Social Enterprise (VCSE) sector and those who use services;
- Ensuring that it is serving the needs of the local people; and
- Using a clear strategy that is championed by committed leaders.
Theme 2: Factors which support effective, well-performing health and care systems
- A shared strategy and vision, that has realistic goals;
- The use of key performance indicators for improvement;
- Leaders who are engaged with the team who deliver and the people who use services;
- Ensuring that people with lived experiences are included in shaping the system;
- Clear, consistent values across the system. This can include good collaboration, sharing learning and innovation;
- Data collection from communities to understand local needs. Also, sharing data across the system in a joined-up way; and
- Ensuring that staff development within the system is considered.
Theme 3: Factors which hinder effective, well-performing health and care systems
- Lack of management support across different levels. This can include changes to priorities and a lack of staff awareness;
- Lack of communication with staff delivering services;
- Weak collaboration and working independently from partners;
- Lack of money or staff; and
- Lack of data and ways to efficiently share data across the system.
Theme 4: Learning from previous reconfigurations
The research explored previous ways to deliver integrated care. Learning about what worked well and less well included:
What worked well:
- The development of relationships and ways of working together;
- Strong local leadership with clear structures for working together; and
- Staff who understood how to meet the needs of local people.
What worked less well:
- At a national level, policies were felt to be inconsistent to support integrated ways of working; and
- Differences in how different partner organisations worked created some tension.
Theme 5: Meeting the needs of the local population
Systems will be expected to ensure that the voice of local people are included in making decisions about the care provided in their area. It has been shown that involving community groups and their ideas can help with this. Systems can look at how to collect feedback from local people and use this information to help ensure that they are meeting their needs.
Theme 6: The role of regulation and assurance
There is little written about how regulation helps to make systems more effective. There may be learning from other nations across the UK. For example, inspectorates in both Scotland and Wales undertake joint inspections. This means that they have experts that cover the skills needed across a system. These have been shown to help make improvements.
Learning for CQC
It will be important for CQC to think about the different circumstances that each system works in. Each system will have a different “starting point”. That means that some areas may have stronger links with partners because they have been working together for longer. Others may still be trying to understand how to they can work together. This will be important for CQC to understand – particularly in the next few years as systems develop.
CQC may want to understand the steps taken towards effective system working. For example, we know that strong relationships between partners leads to better integration and team working. This means that CQC could try to understand to how relationships are being developed and maintained.
There is little in the research that described the role of regulation in a system. CQC can learn from their own work with systems to fill this gap. There could be opportunities to learn from the nations of the UK. Understanding how to best hear from local people will be important for CQC. CQC need to think about how to best reach different people across the system to hear their voices.
As ICSs are relatively new, CQC can help to describe what an effective system looks like. For example, more research can describe examples of good practice across England. CQC should also make sure that they are sharing learning in a way that suits the system. For example, they could provide webinars, papers or a “how to” guide.
This research shows that a range of factors can either help or hinder effective system working. The following sets out some of the key steps.
Who or what are the influencers?
- Systems leaders;
- Staff employed by NHS, social care and VCSE organisations in the system;
- People with lived experience;
- IT and data infrastructure; and
What will they be doing?
- Working together to hear different voices;
- Speaking to partners and people early;
- Using local information;
- Thinking about wider aspects that contribute to people’s health (i.e housing and environment);
- Look for regular opportunities to improve; and
- Effective regulation.
What will be seen?
- Clear strategy and shared vision;
- Structured goals and plans;
- Joint leadership;
- Leaders working together at all levels to make decisions; and
- Use of measures to drive improvement.
What will be the result?
- Empowered staff and population;
- People feeling heard;
- High levels of trust;
- Efficient knowledge and data sharing;
- Improved ways of delivering care ; and
- Improved access to services.
What will this work towards?
- Effective, well-performing systems.
Considerations for future research
A number of areas could be interesting for further research. These include:
- Understanding more about how a regulator can help within a system;
- Learning more from adult social care and what an effective system looks like for them;
- Learning what is important to see in a system from people in communities;
- Learning from other regulatory organisations across the UK; and
- Understand more from areas that have tried integrated models of care in the past.
CQC could develop case studies with real-life learning and examples. This can be shared with systems (and others who are interested). The way that systems will develop will change quickly. This means there will be new opportunities to learn. CQC can play their part in documenting this through further research or evaluation projects.