Being Brave and Bold in Durham and Darlington

Community services in County Durham and Darlington are changing, with a renewed focus on integration. To support this, the three clinical commissioning groups (in conjunction with the two local authorities) that cover the area have committed to a new five year contract for community health services (with the potential to extend up to ten years). This is currently being mobilised by County Durham and Darlington NHS Foundation Trust and will go live on 1 October 2018.

To capitalise on the opportunities this affords, leaders in the system came together at a roundtable event on 18 July 2018 to: consider the role of social prescribing and self-management in an increasingly complex system; to learn from emerging evidence; and, approaches taken elsewhere. Those represented included senior members of the local integration board, CCG and LA commissioners, public health, the NHS foundation trust and representatives of the voluntary and community sectors in both County Durham and Darlington.

Information was shared on the evolving new models of care in Darlington and integrated teams-around-patient services in County Durham, supported by a case study on approaches to adults with complex needs in Plymouth. Each of these provided place-based food for thought. These were further contextualised by a focus on complexity friendly commissioning and collaboration, and a review of the now well established evidence on the impacts of social prescribing.

Following discussion, participants were asked to identify what most stood out from the presentations and to articulate themes for further exploration. Some of the key aspects included:

• Listening to and working with patients/service users – ensuring that both commissioning and service provision are shaped by those using them
• Making time to ‘play’ together to form and strengthen relationships, characterised by trust, to support culture change
• Adopting a bottom-up approach to collaboration, based on sharing and learning
• Exploiting opportunities to overcome organisational barriers including, for example, joint approaches to workforce and organisational development
• Meeting the challenge and capitalising on the opportunities of working within a complex system – but in a safe context
• Ensuring (and this is a tough one) that the assurance requirements of the wider system can be met in ways that do not diminish the potential to creatively achieve real and lasting outcomes for the population we serve.

 

There was a genuine buzz in the room, acknowledging that we need to be bold in the approaches we adopt. Comments following the event included:

 

 

“Really inspired by the session”

 

“Very affected – in a great way – by the presentations”

 

There were also some key challenges. If local ownership and empowerment are essential, are we brave enough as leaders to “let go”? There is more to do to consider the wider determinants of health (e.g. housing, employment and criminal justice) and the role of both primary care and system leaders in maximising opportunities for health and wellbeing in our communities. We would like to think about issues in different ways and reframe the questions we ask service users. Ultimately, we will need to be brave in marrying scrutiny and accountability with more creative, less traditional, approaches.

 

None of this will be easy and we will need to maturely and honestly hold one another to account in a safe environment. Much work has already been undertaken, and the roundtable provided a vital chance to collectively reflect on some of the wider questions facing partners in the County Durham and Darlington Partnerships.

 

So what next? Are we brave enough to really explore what all of this means for us as organisations and the part we could play in our system/partnership? Are we willing to be bold in our approach to shaping services our patients/services users need rather than traditionally what our organisations have been commissioned to deliver?

 

A number of stakeholders have answered yes, and will be participating in a regional event on Friday 7 September entitled Funding and commissioning in complexity: putting it into practice at Newcastle University Business School (unfortunately, places at this event are now fully booked). However, if you’re interested in these new ways of working, you can also join the free online Knowledge Hub at: https://khub.net/group/complexity-friendly-system-oriented-commissioning-pilot-project/group-home. There you’ll find resources for implementing this approach and can connect with other practitioners sharing ideas about how to make it work in practice.

 

Next steps for those of us in County Durham and Darlington include further dialogue both locally and regionally with partners, integration boards and clinical leaders.

 

Copies of the presentations shared at the event and a report on the roundtable are available by emailing lee.mack@nhs.net.

This formal collaboration follows the 12 month North East Building Health Partnerships programme, which brought the STP and voluntary sector together in a workstream that focused on developing Communities of Practice around better ways to commission services. 

 

This blog has been published in parallel by Social Enterprise UK – www.socialenterprise.org.uk

Jane Hartley (VONNE), Lee Mack (CDDFT), Catherine Parker (PHE) and Jenny Steel (CDDFT)