Systems for Change: a whole-system approach
This article forms part of the Systems for Change project, which provides practical learning and tools to support integrated care systems to drive social and economic development.
If you work in an integrated care system, VCSE organisation, local government, business or academia and are looking to bring people together to improve people’s lives, the Systems for Change learning platform has been developed for you.
On the question of how ICSs are making progress on social and economic development, we heard that it is the development of effective system working that is the most important enabler. To enable this, we have identified ten common approaches that leaders can take.
Ten common approaches
1. Build and nurture strong relationships and infrastructure for partnership, especially with and within the VCSE sector and its small grassroots organisations in diverse communities
All systems involved in the learning capture project identify this as the most important thing to get right. Having the relationships and infrastructure for partnership, especially with and within the VCSE sector and grassroots organisations, is central to making progress on social and economic development. This finding is common to lots of work that ICSs are progressing - on health inequalities, social determinants, population health and more - so it is not necessarily new. But through this learning capture project we have pulled together practical learning about how effective systems have gone about this in practice.
As well as formal structures for partnership, many people involved in the learning capture project talked about the benefits of creating opportunities for informal working and relationship building. The role of smaller groups of partners, sometimes in an advisory role to the ICP or even more ad hoc informal get togethers, without agenda or specific business, can be an important and helpful space. This includes things like the shared learning events facilitated as part of this project.
How this happens in practice:
At system level:
- West Yorkshire Harnessing the Power of Communities Programme
- Humber and North Yorkshire VCSE collaborative
- Physical co-location of social and primary care teams in Bristol, North Somerset, South Gloucestershire
In places and neighbourhoods:
- Spelthorne Healthy Communities Partnership, with a VCSE Chair
- Warrington Together
- One Weston Locality Partnership
Links to further resources:
2. Create the right environment and culture for action through policy, strategy and adoption of frameworks
Another common theme in systems where work on social and economic development is progressing, is the coming together around shared priorities and purpose. We heard from systems how strategy development can help in this. Adoption of relevant frameworks – around things like social value and employment practices – can also be used to create a supportive environment and culture for action. Overarching commitments to consider health in all public sector decisions, and vice versa to consider social and economic factors in health planning, is also helping create an enabling environment in many systems.
How this happens in practice:
- Greater Manchester Accord commitment to health in all public policy decisions – like housing, transport
- South Yorkshire Integrated Care Partnership Strategy
- Humber & North Yorkshire ICB action on the cost-of-living crisis
- Development of a social value vison or social value framework
- Sign-up to the social value portal
- Implementation of the NHS Prevention Pledge for all 18 provider trusts in Cheshire & Merseyside
- Adopting the Fair Employment Charter to all institutions and employers across the system, building on work already underway in places like the Liverpool City Region and Cheshire & Warrington
- Greater Manchester Good Employment Charter and Good Employment Week
Links to further resources:
3. Convene and catalyse through system structures and ways of working
Systems that understand their role as a catalyser not controller of action, with unique convening power, seem to more easily navigate and progress their work to support social and economic development.
During the learning capture events and interviews we heard how the structures and strategy of Integrated Care Partnerships (ICPs) in particular present an opportunity to design a supportive operating model that helps create the right climate for action on social and economic development. In practice this means setting up governance and priorities that ensures progress on important issues like diversity and inclusion and climate change, but also creating the right environment and conditions so that community activity action can flourish and those in operational roles in different geographies or working on different thematic priorities within the system can get on with things.
We heard about a number of ways system leaders have created the right climate for enabling different partners to progress practical action in communities. This includes through investing in the infrastructure required for partnership with the VCSE sector, investing in grassroots and VCSE sector activity in communities, and giving NHS staff time within their roles to get involved in community activity.
During the learning capture process we repeatedly heard the phrases ‘set things up and let go’ and ‘get out of the way’ in relation to what form ICPs should be taking to make progress on this purpose. We heard first-hand how the flexibility ICPs have to develop their leadership structures in a way that suits the local system is important, and how having different partners – from local government and the VCSE sector - in leadership roles across and within the system is helpful. In this aspect, the currently permissive nature of ICPs is essential.
We also heard how system leaders have spent time together, working to think through and understand how existing structures, governance and programmes work at place, and across different thematic priorities like mental health and children and young people. We saw how having flexibility to design and build the system around what already exists is helpful, and how important it is for partners to think through and agree how, and where, health is involved in local social and economic spaces alongside local government and the VCSE sector being equal partners in the integrated care system. Maintaining communication amongst system leaders from the different sectors happens in different ways, often outside of formal board meetings, with regular scheduled meetings where system leaders can raise issues and design solutions together.
The importance of taking the time to do this work to understand how coordination will happen at system, place and neighbourhood levels is already known from other work like the NHS England Embedding VCSE in ICS programme and NAVCA’s peer support network for VCSE Alliance leads. Again, we heard how enabling different partners – from local government and the VCSE sector – to take the lead on thematic or place-based work is helpful.
How this happens in practice:
- South Yorkshire mayor as chair of the integrated care partnership.
- South Yorkshire defining communities first approach in their Integrated Care Partnership Strategy.
- In Humber & North Yorkshire there is a joint chair of the ICP and ICB to provide link up between strategy and delivery. The ICP co-chair is a local government councillor and partnership member of the ICB.
- In West Yorkshire VCSE leaders meet regularly with the Health and Care Partnership chair and chief executive to raise issues being seen on the ground in communities.
- VCSE Chair of Humber & North Yorkshire Health and Care Partnership Workforce Board.
4. Embed and empower people with protected time and skill to make the connections across and within the system
It was common across all systems involved in the learning capture, that the people with the roles and responsibilities for enabling partnership working and relationship building are vital to knit things together. In the systems where work on social and economic development is progressing, having people within the system with the protected time and skill to agitate, make connections and progress this work is a defining characteristic. There are different approaches being taken but what is important is that time to make these connections is protected, and that people have the leadership skills and working styles for the role. As one interviewee told us “this is about getting out from behind the desk, putting your jeans and t-shirt on and meeting people in the community.”
How this happens in practice:
- Full-time ICS directors of partnerships and sustainability.
- Place-based leads with responsibility for building community relations and partnerships.
- Quarterly meetings in West Yorkshire between VCSE leaders and ICB chair and CEO to discuss and trigger action.
- Joint roles across the NHS and combined authority in West Yorkshire include the assistant director for public health, mayor’s inclusivity champion and head of regional health partnerships.
- Joint roles across the NHS and local authority in Surrey Heartlands.
Links to further resources:
5. Develop shared understanding of local population, needs and opportunities
Partners in many systems are working to bring together different forms of data, intelligence and insight from a variety of sources. This is helping establish a shared understanding of the population across the system to help identify the most pressing needs and opportunities for social and economic development. With this as a starting point, systems are then able to put their time and resources into the things that will make the most impact.
How this happens in practice:
- Humber & North Yorkshire Integrated strategic needs assessment
- South Yorkshire investment in a public health intelligence system and comprehensive needs assessment
- Humber & North Yorkshire ICB action on the cost-of-living crisis built up from understanding of the issues and support required in populations across Hull, York, East and North Yorkshire and Northern Lincolnshire to create a system-wide response that enables the population, their employers, and the community and voluntary organisations that support them, to minimise the impact of rising costs.
- Bristol Health Integration Teams support projects that bring partners together and generate evidence to support service development.
Links to further resources:
6. Bring in external expertise and advice, and create opportunities for shared learning about new ways of doing things that change culture
Many systems told us about the helpful role that external expertise, advice and training can play in helping partners find new ways of doing things. Bringing in a fresh perspective can support culture change.
How this happens in practice:
- System-wide training on community development in Surrey Heartlands
- System leaders training on Bloomberg Harvard City Leadership Initiative
- South Yorkshire Health Action Advisory Panel
- West Yorkshire co-production of pathway to support people of working-age after stroke, in partnership with the NHS Leadership Academy, Stroke Association, local VCSE organisations and people with lived experience.
Links to further resources:
7. Work to reduce practical barriers to system working
In many of our conversations we heard how systems are identifying and tacking barriers to reduce frictions to system working. There are different aspects to this. On one hand we heard examples of how systems are working to make it easier for people to find out who is who, who does what and how to contact them. In other systems there is a focus on innovation and reform of commissioning, procurement, contracting and budgeting to enable more partnership working. The need for access to shared budgets and time for training is another aspect.
How this happens in practice:
- Development of a new Grants Framework by the Two Ridings Community Foundation in partnership with the procurement team.
Links to further resources:
8. Establish ways to measure progress
During this project there were many interesting discussions in systems about the importance of measuring progress, how this can be done and be used as a lever for action. It is not clear cut. Different systems are exploring different approaches to measuring their progress on supporting social and economic development.
In relation to what institutions within systems can do around the anchor agenda many felt that identification of clear system-wide targets – for example about the real living wage, reducing emissions and purchasing from local suppliers – is helpful. A financial measure of how much systems are investing in early intervention and prevention was also felt to be a potentially helpful lever to encourage action. Using the health of the VCSE sector as a proxy for progress is another way progress on social and economic development is being done.
More widely, including measures on employment and deprivation within system data dashboards is being used. At the same time, we heard some people express caution about a purely outcomes-based and data-driven approach on this purpose given the complexity and cross-cutting nature of this purpose and the importance of innovation, taking risks and trying different approaches. All systems agreed on the importance of using more qualitative ways of measuring progress alongside data given this purpose is about people and their lives.
How this happens in practice:
- South Yorkshire outcomes framework and dashboard to support ICP strategy.
- Cheshire & Merseyside dashboard
- Sustainability of VCSE sector as part of the risk register of West Yorkshire ICB
- Health and Wellbeing Dashboard on the Surrey Index.
Links to further resources:
9. Make resources available when a need or opportunity is identified
Wider work on successful partnerships in health and care consistently shows that investment and resources in the structural infrastructure needed for partnership with and within the VCSE sector, alongside investment in delivery, is an essential component for success. It was therefore no surprise that all systems involved in the learning capture project are directing investment and resources towards partners to fund both infrastructure for partnership and delivery. With relatively small amounts of money, this financial investment alongside the sharing of other resources (like spaces, back-office functions and vehicles) is enabling more rapid progress on social and economic development.
How this happens in practice:
- Bristol, North Somerset, South Gloucestershire Apprenticeship Levy Bank
- West Yorkshire health inequalities and other funding
- South Gloucestershire Prevention Programme
- South West Health & Wellbeing Challenge Fund
Links to further resources:
10. Celebrate success and share good practice
Throughout the learning capture process, we have seen first hand how valued and celebrate success – within and across ICSs and regions. This feels to be particularly important at a time when national policy trends are towards giving more autonomy and devolving of authority to local systems, potentially reducing feedback loops for sharing good practice, and as systems themselves devolve authority to place-based and neighbourhood structures for the design and delivery of services.
How this happens in practice:
- Surrey Heartlands Expo 2023
- Research and promotion of the value and impact of the Yorkshire and Humber VCSE sector, its contribution to the economy and health and wellbeing
- Regular communications and bulletins about the work of the Humber and North Yorkshire VCSE Collaborative and Harnessing the Power of Communities Programme in West Yorkshire
- Shared learning events, like those held for this learning capture project
Links to further resources:
- NAVCA VCSE Alliance peer support network
- NHS Confederation ICS Network
- Working in partnership with the voluntary, community and social enterprise sector’ workspace on the FutureNHS platform. Those working in organisations outside the NHS can request access.
Find out more about the Systems for Change project and access a range of resources.
