Learning and improving across systems

This blog originally appeared in the Health Service Journal (HSJ).

Amid the relentless financial, operational and workforce challenges facing the NHS, building effective cross-system approaches to improvement can often take a back seat. But it’s vital that this work isn’t pushed to the sidelines, as neither present nor future issues can be solved without more effective collaboration across organisational and professional boundaries. 

With structures in place that have the potential to support more effective working across health and social care, systems now need to prioritise translating this into tangible improvements to the health and wellbeing of our local communities. Seeing and celebrating this positive impact on people’s lives will help maintain the energy behind system-working.

The Health Foundation, the Q community and NHS Confederation are working together to understand how we can help health and care systems across the UK to focus on improvement and offer support to those engaging in this work. We’re hearing from local integrated care system (ICS) leaders that further building the skills and culture to improve care across systems is needed to bridge the gap between what’s currently possible and their bold ambitions for change. 

This is inherently complex work and will be different in each local context. Improving services across a local area not only requires technical capability, such as the data and analysis skills to map what’s happening and methods to surface and implement workable responses, it needs the culture and infrastructure for effective collaboration across multiple organisations, communities and staff.

Given the evidence points to sustainable transformation taking time, it is not surprising that many ICS leaders are keen to emphasise that they are at an early stage in a long journey. The need for clear markers of progress before enthusiasm dissipates means it is critical that systems build on what is already working well.  

There are examples of people working together across organisational and professional boundaries to improve services in every part of the UK, from improving patient flow to addressing inequalities. Some of these examples are featured in a recent report published jointly by NHS Confederation, the Health Foundation and the Q community.

NHS Confederation’s ICS Network provides a forum for ICSs to share examples of this kind of inspiring work. The Q community, led by the Health Foundation, is bringing together thousands of people with expertise in service improvement across the UK and Ireland, collaborating to share knowledge and support each other to make faster progress.

Our ambition is to make this activity and expertise more visible to enable a greater contribution to solving the biggest collective challenges. We can support learning between systems as well as help each system develop embedded cultures and processes to make the most of what’s being learned locally. 

NHS England has set the expectation that all the NHS organisations, systems and providers will embed NHS IMPACT, the new single, shared NHS improvement approach. While it’s encouraging to have national support for improvement and ICSs, working through what this will mean in practice is best led locally given the wide variety of practice, structures and cultures. |Translating the ambition and principles of NHS IMPACT at a system level will require approaches to be co-developed with local government, the voluntary and social enterprise sector and communities.

NHS Confederation, the Health Foundation and the Q community are joining forces to launch a new partnership to support health and care systems across the UK. We see opportunities to galvanise change and enable innovation to thrive in three interwoven ways:

• encouraging and convening people, connecting promising work to the support needed to accelerate change
• bringing together partners to co-design and drive improvement in areas that require cross-organisational action 
• enabling effective collaboration, developing the partnerships and culture needed to stimulate improvement and learning.  

Working in partnership, NHS Confederation, the Health Foundation and the Q community are offering a peer-learning programme, which is now open for applications. We are looking for people tasked with improving care across their health and care system anywhere in the UK – you could be working at the place or system level or across organisations and could be either within or beyond the NHS.

Together we will be connecting leaders to local improvement ideas and expertise that can help tackle the challenges they face. We aim to join up pockets of well-designed and evidenced change that currently lack visibility for at-scale implementation. We will pool evidence and experience between systems across the UK to understand and make progress on a few priority topics. We will also be sharing publicly what we learn and will use this to help influence national policy.

Under intense pressures, it’s easy to retrench. But together, working closely with system leaders, we can hold and develop the vision for local system improvement, enabling this way of working to fulfil its potential for our communities.

Matthew Taylor (@ConfedMatthew) is Chief Executive of NHS Confederation.

Penny Pereira (@PennyPereira1) is Q Managing Director.