The 2019 NHS Long Term Plan commits to the further development of Integrated Care Systems (ICSs), with ICSs to cover all of England by April 2021. ICSs bring together local organisations in an effort “to redesign care and improve population health, creating shared leadership and action”, seeking to deliver the “triple integration of primary and secondary care, physical and mental health services, and health with social care”. Against this background, it will be crucial to better understand the challenges facing the (further) development of innovative delivery systems such as ICSs, and to identify ways to address them. There is a need to explore the key factors that promote (or hinder) the establishment of shared leadership and action locally as envisaged for ICSs, recognising that these will vary across local systems, and to identify the core elements acting at the different tiers of the system, and their interrelationships, that effectively and sustainably support the implementation, sustaining, spreading and, where appropriate, scaling of service innovations such as ICSs, especially in the most potentially difficult settings.
This project will contribute to advancing our understanding of these complex issues by exploring the experiences of a selected set of countries in Europe that have introduced similarly innovative delivery systems that seek to bring together health and social care locally. Cross-country policy research offers opportunities to examine similar challenges using the lens of different system contexts to identify the key components, mechanisms and factors that are involved in service innovation and that may then inform health and care policy in England. Our focus is on understanding the policy processes that are involved at the different tiers of the system, and to explore the nature and role of different contextual (regulatory, administrative, financial, cultural) factors in embedding new ways of working into the care process. Our ultimate aim is to expand the range of (policy) options for health and care leaders in England to effectively implement innovative delivery systems with similar ambitions.
The project involves in-depth, international comparative case study research to help inform the further development and roll-out of innovative, population-based service delivery approaches in England to best meet the health and social care needs of populations locally. Focusing specifically, but not exclusively, on governance and accountability arrangements, we seek to:
- systematically explore the key factors at local, regional and national levels that influence, directly or indirectly, the establishment and further development of innovative, population-based service delivery models or systems in a small number of European countries;
- identify the lessons that are applicable and transferable to England from other countries’ experiences with innovative, population-based service delivery models or systems; and identify what would need to be put in place in England to increase the odds of similar English initiatives becoming sustainable and scalable.
Our principal approach is that of comparative cross-country case analysis. We envisage an iterative approach analysing the a range of cases and settings in the Netherlands, Italy and Scotland. Case studies in each country will involve:
- Document review including policy statements and evaluation reports;
- Interviews with leaders, managers, front line staff and user representatives involved in the development and implementation of the service/system innovation under consideration;
- Interviews with government officials at the different administrative tiers to understand the wider context within which these service/system innovations have been or are being developed and implemented and systems put in place to support innovation locally.
We are currently not envisaging undertaking a separate England case study but instead will systematically draw on the findings of ongoing national evaluations and we foresee regular engagement with the relevant evaluation leads through workshops to share insights and to identify lessons to help inform the further development of innovative service delivery systems in England.
The recent inquiry by the House of Commons Health and Social Care Committee into integrated care in England has highlighted the very many changes that are taking place to better join up services at the different tiers of the system while also emphasising that successful transformation which is key to sustainability will require “dedicated national financial and leadership support to enable the NHS to transform at pace”. The inquiry has highlighted the need for funding and legislative change to support this process. This project will further inform this process by providing much needed evidence on the impact of factors, such as the role of power relationships between different stakeholders at the different levels of the health system, that have received less attention. It will also provide evidence as to the types of strategies that are likely to work best in different contexts and under which conditions to help sustain and spread service innovation, keeping the complexities involved in mind.