Last Updated on April 28, 2016

The Local Government Association has published The journey to integration: Learning from the seven leading localities, an independent report detailing the experience of seven localities in developing integrated care.

The report attempts to understand the successes and challenges of the localities on the journey to integration. It examines each locality against a range of factors, including care model, leadership, workforce, payment model and information flow.

The introduction states that, ‘It is clear from the findings in this report that in some areas significant impact has been achieved through integrated care approaches. The extent to whether or not this impact has been achieved is closely related to whether or not there have been any changes in the flow of money and information or in governance arrangements. It may seem obvious, but putting these in place has been hard work in which many have invested sufficient effort. It has also taken a long time. The highest levels of achieved impact are in areas that have been pursuing integration from 10 to 15 years. While areas that are earlier in their journey may not have achieved as much, these examples serve as a benchmark for what can be achieved and provide a strong learning opportunity.’

The report was commissioned from Carnall Farrar by the Local Government Association. It concludes that it is possible for integration to have significant impact in terms of improved health outcomes and financial sustainability, and sets out the key lessons for other localities to consider in embarking on integration themselves.

The main headlines are:

• It is possible to have dramatic impact.
• An essential starting point is a shared vision and commitment from a leadership coalition.
• Long-term tangible changes in how care is delivered at scale across the whole area are required.
• Population focus and segmentation are critical but it is not enough to focus on the top one or two per cent of the population.
• Care delivery changes have common themes of more preventative, proactive and also more responsive care.
• Significant differences exist across the case studies in the specific care models adopted and the balance in who does what, and this seems to be driven by the relative strength of leadership and where it sits.
• The flow of information is an essential pre-requisite to make change happen and must be taken out of the ‘too difficult’ box.
• Changes in payment need to be made to fund direct costs of changes in care and change incentives for organisations.
• Changes in governance are essential to allow change to happen but form must follow function.

The report is available to read on the LGA website here.