Supporting integrated care in practice

Abstract

Purpose The purpose of this paper is to investigate the perceptions of key informants on a national support programme for the development of new care models (NCM) in England (2015/2016–2017/2018). It focuses on the perceived facilitators and barriers affecting the development and implementation of the NCM programme and offers some insight into the role of national level support in enabling local integration initiatives. Design/methodology/approach A set of 29 interviews were carried out with a variety of respondents at the national level (including current and past programme leads, strategic account managers, advisors to the programme and external regulators) between October 2017 and March 2018, and analysed thematically. Findings A set of facilitative elements of the programme were identified: the development of relationships and alliances, strong local and national leadership, the availability of expert knowledge and skills, and additional funding. Challenges to success included perceived expectations from the national Vanguard programme, oversight and performance monitoring, engagement with regulators, data availability and quality, as well as timetables and timescales. Crucially, the facilitators and challenges were found to interact in dynamic and complex ways, which resulted in significant tensions and ambiguities within the support programme. Research limitations/implications While the sample was drawn from a range of different senior players and the authors ensured a diverse sample associated with the NCM support programme, it inevitably cannot be complete and there may have been valuable perspectives absent. Originality/value The paper demonstrates that the analysis of facilitators and challenges with respect to the national support of implementation of integrated care initiatives should move beyond the focus on separate influencing factors and address the tensions that the complex interplay among these factors create.

Do Policy Implementation Support Programmes Work? The Case of the Care Act 2014

“…However, there are some glimmers of hope which suggest that this compartmentalised approach to policy implementation may be shifting with evidence of a growing interest in learning from implementation support approaches. This was especially notable in the development of the respective support programmes for the Care Act 2014 and NHS Vanguards initiative (Billings et al, 2019;Checkland et al, 2019;Coleman et al, 2020). In the case of the latter, this research commenced upon completion of our study of the Care Act IS programme and was informed by our work.…”

Developing architecture of system management in the English NHS: evidence from a qualitative study of three Integrated Care Systems

“…With publication of The Five Year Forward View ,8 which laid out a vision to improve care delivery through breaking down barriers between different organisations and care sectors, ‘integration’ became a formal policy objective . This led to policy initiatives which focused on improving the coordination of service provision across organisational boundaries such as the Vanguard New Care Models Programme and the Integrated Care and Support Pioneers exemplars 9–11. Alongside these developments, Sustainability and Transformation Plans were first introduced in 2015 as NHS organisations and local authorities (which are responsible for social care provision) were asked to work together to develop services for their local population 12.…”

Policy success: What is the role of implementation support programmes?

“…In order to identify any previous approaches, we analysed several relevant previous national policy programme evaluations. There was limited analysis of the implementation process and how this was supported in these studies (Billings et al, 2020; DCLG, 2015, 2016; DfES – Department for Education and Science, 2002; DH/Health and Social Care Change Agent Team, 2004; Henwood & Wistow, 1993). Some approaches to IS were difficult to identify in any visible tangible form, some were more experiential (inspiring leadership and/or management), and others were simply theorised (participation in regional meetings will facilitate ‘x’ and ‘y’).…”