Tips for working with Integrated Care Systems

Learning from West Yorkshire Integrated Care System

West Yorkshire seems to be getting it right in how it works with the local Healthwatch and it’s residents.

After seeing this article by the Good Governance Institute,  Stacey Appleyard, Director at Healthwatch Kirklees, was kind enough to spare some time to talk to me about whether the article reflected reality.

She was able to confirm that West Yorkshire Integrated Care System (ICS) works really well with the local Healthwatch, and told me some of the factors that brought this about:

Value

Years before the development of the Integrated Care Board (ICB), the group of West Yorkshire Healthwatch strived to show system leaders the value they brought. This not only showed system leaders their local knowledge and how Healthwatch could talk to communities in a way that public services couldn’t, it also helped nurture a culture of valuing public involvement and putting understanding what people were thinking at the core of the system’s work. Kirklees have never needed to invoke their statutory powers.

Compromise

Sometimes building the relationships and mutual respect took compromise, occasionally including consciously prioritising a system issue over others. This investment of core resources into some system wide projects benefitted the system and helped to evidence value.

Time

As indicated above, it was a long game, with a decision early in the development of the Local Healthwatch in West Yorkshire that they would have a focus on system working. As Stacey stated, ‘it’s not going to happen overnight’.

Relationships

Obviously it is all about relationships, and early on the West Yorkshire Healthwatch decided to offer support without seeking commissions or additional funding. By the time that became unworkable and the Local Healthwatch needed funding to service the ICS, this was much more readily accepted by the ICB.

Their relationships enhance their value because they are able to speak to the right people and challenge them to make their engagement about specific issues based on their strategic priorities. For example by helping staff dig down into what they need to know beyond ‘what do people think?’ they’ve helped them realise they need to speak to people with chronic conditions and accessibility issues to hear new, useful patient experiences.

Also key are the relationships between the West Yorkshire Healthwatch, they are all local independent providers and so able to make agreements with each other and stick to them. This has built trust and they talk with each regularly and offer mutual support. They even have an agreement that they will not tender for each other’s services should they be advertised.

Advantages

West Yorkshire also had some natural advantages. The geography means that it has always made sense for the Local Healthwatch in West Yorkshire to work together. Their commissioners have mostly given grants in the region, and although these can be removed if a Healthwatch is not working effectively, it reduces the tension of needing to retender for most of the group.

Conclusion

Whilst advantageous circumstances provided a strong foundation, West Yorkshire Healthwatch have worked hard and made compromises to nurture relationships with their system, and this is now paying off.

They provide briefing sessions to the ICB prior to their Board meeting to ensure they understand what the involvement of the public is telling them, to inform decision making.

The system helps Healthwatch to ensure their priorities and projects will have impact, with an additional £4.5m helping better access to dentistry due to Healthwatch work, and Kirklees developing projects where they are part of the solution utilising co-production, as well as raising the views of their residents.

Thanks again to Stacey for speaking with me.