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Moving from the margins: The challenges of building integrated local services

Turning Point and Collaborate recently convened a group of expert practitioners to explore an important and pressing question: why, despite the relative maturity of multiple models, and evidence of their effectiveness, do integrated systems remain at the fringes of local public services?

The discussion was motivated by a combination of optimism, frustration, and realism. Optimism around the possibilities that lie within outcome-focused integrated services at the local level. Frustration over the fact that an antiquated approach to public service delivery is frequently the default position, and that despite the current context of devolution, austerity, and inequality, integration remains the exception rather than the rule. The feeling of realism came from the shared understanding that change won’t happen without a significant shift in process and behaviour.

This Discussion Paper captures the insights generated from the discussion. It reflects on the challenges that face those who believe integrated services offer an effective and affordable way of improving local outcomes and are shifting their work away from the margins. Contributors to the discussion were highly cognisant of the financial and demand challenges facing local public services. Yet the challenges were felt to be products of the behavioural, the cultural and the systemic, rather than the purely financial pressures within the system. The paper also reflects on the changing policy context, acknowledging the fact that current drivers such as the NHS Five Year Forward View and its new models of care; the Vanguard programme; and local government-led service reform, are encouraging more integrated models at scale. Hard work will be needed to ensure that people using services feel the benefits of such integration.

Part of the aim of this discussion paper is therefore to make the case for overcoming a sort of collective amnesia, in other words learning from - and implementing - existing models, rather than starting again from scratch.

An analysis of the roundtable is presented as seven insights for building integrated local public services. The insights are relevant to those considering the delivery of effective public services across whole places and systems. The combination of the current political, economic, and social context coupled with the presentation of credible models of community-led integrated care, makes a compelling argument for these insights to be taken seriously.

In order to move the discussion away from the abstract and ground it in something tangible, a number of models were explored, including Turning Point’s Connected Care model, the MEAM Approach, developed by Making Every Adult Matter (a coalition of Clinks, Homeless Link and Mind), and the West London Zone for Children and Young People. We are, of course, acutely aware that integrated service models are already part of the landscape we seek to influence, and that there are numerous examples across the United Kingdom and beyond of public services being designed and delivered in innovative and integrated ways. However, as previously stated we have some way to go before this is systematic in practice. The decision to focus on these three initiatives is not intended to dismiss others, but rather to characterise the various routes to change when considering integrated public services. Connected Care, the MEAM Approach, and the West London Children’s Zone - with their different starting points, methodologies, and perspectives - all demonstrate aspects of the seven insights, and this will be evidenced throughout the paper.

Collaborate and Turning Point intend to use this discussion paper to support their future work, and challenge others to consider these insights within the context of local service design and delivery.