By James Carter
Wide reaching ambitions for Integrated Care are at risk from a highly complex and febrile environment, yet developments across mental health services, the wider voluntary sector and those advocating for change may offer some insight to ensure a chance of success.
The complexities that exist for these new Integrated Care Boards (ICBs) cannot be overestimated. Amidst the existential threats of pandemic recovery and workforce exhaustion, a commitment to communities and resource allocation requires reflection, trust and time. Yet these qualities are often viewed as incidental or assumed.
Delivering effective support to people with mental health challenges is as complex as the stage set for the development of ICBs. The stresses people experience during the life-course, combined with the stark inequalities faced by communities, mean that a responsive, connected, humble and respectful approach is required. Building on Ed’s excellent briefing on mentally healthy Integrated Care Systems (ICSs) and the work we have been undertaking as a team in the South East, it has become apparent that ICSs could learn from the systematic ambitions of mental health transformation by providing holistic care to communities which is responsive, relevant and focused on the needs of individuals.
These joint responsibilities for the population’s health require an Integrated Care Partnership (ICP) which aims to bring together partner organisations focused on improving health needs alongside a commitment to addressing health inequalities. Mental health transformation approaches have highlighted the value of focusing on communities, harnessing the skills and talents of the voluntary sector to support the ICB’s “duty to collaborate”. Examples of newly contracted “Mental Health Alliances” aligned to the ambitious Community Mental Health Transformation Framework, where the voluntary sector take an equitable role alongside statutory partners, can create a level of connection and relationship which would benefit wider ICB considerations.
Compassionate and open leadership in this new paradigm is crucial across all levels of the structure to “hold the space” between the constituent partners, both vertically (across organisations) and horizontally (operations at neighbourhood/place/system level). Supporting this level of complexity might be achieved through an alternative approach to developing and delivering public services known as “Human Learning Systems” – of which a body of evidence is emerging. Many organisations and interconnected systems in mental health are adopting this approach in redefining their response to multi-layered complexity – examples exist in Surrey and Plymouth amongst many others. This shift to a new way of working is building social movements connecting system, place and neighbourhood.
Feedback, listening and learning are the key skills for all to undertake in this paradigm. The deployment of “System Stewardship” is an interesting concept: multi-organisational workers and communities being given the time and space to observe, build trust, listen and learn together across all elements of the system is crucial to navigate this ship of complexity. The question is whether these skills, learning and new ways of working will be given the time and permission to embed in turbulent times.
For more thinking on this – Duncan Green sets out the principles of working in systems, and to dig deeper, read Thinking in Systems by Donella Meadows.
Check out our jargon-busting guide to Integrated Care Systems
