Who?
Frimley Health & Care Integrated Care System (ICS) is a partnership of NHS, health services, local authorities, voluntary sector, and local people working to improve patient outcomes across parts of Berkshire, Hampshire, and Surrey. The ICS is well-known for being innovative, forward thinking and a leader in health and social care – but faces the widely-felt challenge of how to deliver an effective urgent and emergency care system (UEC).
The challenge
Despite being a high performing ICS, Frimley ICS still faces serious challenges with their health and social care, particularly in UEC. Multiple compounding factors exist including:
- An ageing population
- Increasing complexity of conditions
- Increasing complexity and volume of mental health cases
- A reduced workforce
Admittance to UEC services is increasing year on year and they face crisis levels of attendance this winter.
Frimley recognised a need for an ICS level UEC strategy and engaged us to deliver a 5-year strategy to tackle these pressing issues. They needed support to navigate the complexity, understand different perspectives, and have clear recommendations on the way forward and why. Only then would it be possible to deliver an effective strategy that would make a real difference to people in the Frimley area.
How did we work and what did we achieve?
Over 12 weeks, our expert team worked closely with health and care staff across Frimley to develop and apply a bespoke strategy approach that was rooted in evidence, rigor of thinking and logic. We wanted to make sure that the ICS and people who live there would see tangible results from the strategy and our work.
Our approach centred around five key tenets:
Outcome driven
To bring clarity and direction, the outcomes Frimley wanted to deliver were at the centre of every conversation. Throughout its development, the team constantly tested recommendations against these outcomes – if they did not ladder up, the recommendation wasn’t carried forward.
This means:
- The strategy provides a clear line of sight from vision to outcomes to the tangible interventions that enable them.
- The ICS can overcome lack of clarity, divergent views, and strained relations between providers.
- Frimley can continuously test against outcomes as they need to pivot and change.
Thinking as a system
Health and care is complex, and simply fixing one problem can have limited, and sometimes negative consequences. We worked to understand the interconnectedness and cause and effect that different actions had, allowing us to ensure recommendations were not point to point solutions.
As a result:
- UEC understands it cannot act in a vacuum and plays an important part in wider proactive and preventative care
- Frimley takes a holistic approach to how it responds to the evolving needs of its community and the health of its people
- The system can manage future UEC demand and make the area a healthier place to live
People focused
We negotiated a complex stakeholder environment through a structured and comprehensive engagement plan. We undertook interviews with over 130 participants and conducted five workshops with participation across the health and care system from leadership to front-line staff. This meant individuals from across health and care gathered in the same space and were able to have tough but productive conversations.
This focus enables:
- Increased mutual accountability and enabled risk sharing across partners in the ICS
- Increased system-wide the alignment and a more joined up way of working
- Reduced risk of duplication of effort and conflicting investments
Evidence base
We ensured that our interventions were centred around data and best practice. We used insight on what has worked in improving UEC care domestically and internationally, linked to the needs of the population. Leveraging our internal specialist expertise and wider external network also ensured we considered the latest thinking within and outside of UEC.
Developing the strategy in this way means:
- Inclusion of relevant innovative ideas, required to make the radical change needed.
- It is data driven and can stand up to future challenge
- The ability to measure success. For instance, our interventions outline key metrics that Frimley can use to track progress and realign as required.
Considering the practical
A strategy is only as good as its implementation and throughout its development we considered potential challenges to execution including alignment, complexity, timescales, and cost. This meant that the strategy we developed, whilst ambitious, was implementable, particularly in the current political and economic climate.
To support implementation we delivered:
- Recommendations to implement as part of each intervention.
- Clear traceability of interventions back to the outcomes.
- A guiding policy and decision-making framework to support discussion on strategic choices that will need to be made throughout execution
As a result of this work, the Frimley ICS team have a strategy that has broad consensus across the system on how to make real progress in the short and long term. With this clarity, the team can now focus on implementing the recommendations to bring about change for urgent and emergency care so that people can get treatment in the right place at the right time.
Where next?
Our health and strategy and customer teams are in conversations with a range of ICS’ on how to support them to develop system level strategies including those for effective urgent and emergency care.
Find out more about what we’ve achieved for other clients in Health & Care.
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