This emphasis has grown in recognition of the fact that while working together across the wider geographies covered by ICSs (which usually span populations of more than a million) may be helpful for issues that benefit from being tackled at scale, most of the work to integrate care and improve population health will be driven by partners collaborating over smaller geographies within ICSs, in the places where people live, work and access services.
There can be a tendency for discussions about ‘systems’ and ‘places’ to focus on system wiring and governance. But our recent work exploring the development of place-based partnerships and the examples that will be showcased during this week’s conference illustrate what place-based working is really about – people working together to make a very real difference to the health and wellbeing of local communities.
Last week, we published Developing place-based partnerships: the foundation of effective integrated care systems. Based on in-depth research carried out over the past year, the report explores the potential role and contribution of place-based partnerships and how these opportunities can be realised. A key takeaway is that while ‘place’ may be on the national policy agenda, making a success of place-based working is primarily a local endeavour.
Places vary widely in their scale and nature, reflecting differences in geographies, populations, organisational contexts and historical relationships. The ability to reflect and respond to these local characteristics is critical. In line with this, our report doesn’t seek to define a single recipe for success. Instead, it presents a menu of approaches, setting out a series of principles to help guide local health and care leaders in their efforts. We hope systems and places will find these useful to consider as they establish their priorities and think about how they can best be delivered locally.
The points below focus in on just a few of these principles.
- Partnerships involving a broad range of agencies and sectors are able to draw on a wider range of levers to influence health outcomes, so some of the most promising opportunities to make progress come from building broad multi-agency partnerships involving local government, NHS organisations, voluntary and community sector organisations and communities themselves.
- Wherever possible, partnerships should seek to build on pre-existing agendas and relationships rather than trying to superimpose new structures. For example, the role of health and wellbeing boards and how they may evolve alongside place-based partnerships came through particularly strongly in our research.
- There are advantages to having some NHS budgets controlled at place, particularly in terms of enabling resource pooling between local government and the NHS, but in the context of clinical commissioning group mergers there is a risk these benefits could be lost. National NHS bodies will need to offer more clarity and support to enable ICSs to delegate some NHS budgets to place level and to use these flexibilities to develop a more joined-up approach to resource management, embedding an ethos ‘one place, one budget’ (even if budgets technically remain separate).
Of course, these local efforts are all well and good, but they will need to sit within a supportive policy and regulatory context to flourish. As Richard Murray explored in his blog last week, allowing locally led change can create some uncomfortable tensions for national policy-makers (for example, the risk that variation in local arrangements could create a lack of clarity around accountability). But our work strongly suggests that it is worth working through these tensions as there is a bigger prize at stake if places can design solutions that make the best use of local assets to make genuine strides forward on joining-up services and improving population health.
The examples we’ll be hearing about at this week’s conference are just a handful of the many examples of successful place-based working that exist around the country. We look forward to continuing to learn from and work alongside local areas as they expand on these efforts through the development of place-based partnerships.