Building trust: integrating health and social care in Salford

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The issue

Health care commissioners and providers in Salford have been at the forefront of moves to break down barriers between services and provide more joined-up care for patients with multiple and complex needs. In July 2016, they launched a new Integrated Adult Health and Care Commissioning Joint Committee; representatives from the local authority and the clinical commissioning group (CCG) came together in a single body responsible for overseeing the funding and delivery of all health and care services for adults. The Committee brought together elected politicians, GPs, officers from the local council and managers from the CCG. Incorporating such a wide range of experiences and perspectives meant the Committee needed to work in new ways across professional boundaries, building trust and developing new relationships.

What did we do?

We were asked to support the newly established Committee with a nine-month organisational development (OD) programme. While there were some existing relationships between council officers and CCG managers, the councillors and GPs had no history of working together. A key objective, therefore, was to develop and strengthen relationships.

We started – as we do in many of our OD programmes – with interviews and research to understand the particular issues facing the group, and this guided how we worked with them. The data revealed many shared values and commitments but also highlighted differing perspectives and assumptions. By surfacing these, they could be openly discussed in facilitated development sessions, using a range of different tools and approaches to support constructive conversations.

The development sessions covered a range of issues such as system leadership capabilities, priority-setting and developing a shared understanding of strategic commissioning. The programme was flexible, which meant we could respond to needs as they emerged, whether that was to share learning between GPs and councillors, or work on real issues they were facing as a group, such as the impact of proposed service cuts.

What was the impact?

Our work helped the Committee move from being a group of disparate individuals with a common aim to one with open and constructive ways of working to help them achieve shared goals. It revealed many complex issues and difficult tensions. The value we brought was not to ‘resolve’ these issues – indeed some of them may not be resolvable – but to bring them to the surface so that they could be discussed rather than left as unspoken obstacles to progress.

One of the signs of the programme’s success was the willingness of participants to take the skills they learned in the development sessions and apply them during their day-to-day work, for example, applying a set of principles to work with that were reviewed at the end of every meeting. They also invited us to observe their meetings and to offer feedback based on our work with them.

Our recent work with The King’s Fund has been instrumental in helping us to be honest with ourselves and our system colleagues. It has provided a safe space to share genuine concerns and demonstrate through individual conversations that we are all truly working for the benefit of the people of Salford. The respectful and considered but persistent challenge from [the Fund] helped us on our road to building trust and agreeing shared ambitions for integrated care amongst committee members.
CCG Chief Officer