Collaboration and system working

In our State of Care report for 2018/19, we said, “The challenge for government, Parliament, commissioners, national organisations and providers is to change the way services work together, so that the right services are being commissioned to deliver what people need in their local area.”

We have found that the amount of progress being made in system working varied, with some good examples of local system working but some examples of ineffective coordination. Evidence from our focus groups with inspection staff and external stakeholders for this year’s report suggested that things were moving in the right direction. We heard that providers were more willing to work with others in the system and could see the benefits of working collaboratively.

We have seen evidence of this during the pandemic, with some excellent examples of good joined-up care between health and social care professionals working together to keep people safe. In some cases, plans for more integrated working that providers have long wanted to implement were put into action in a matter of days. Examples included care homes being aligned to GP practices to support better care planning, and clinical commissioning groups working with local authorities to provide all local care homes with an iPad and video conferencing so that GPs could do virtual ward rounds in addition to physical visits.

In the prison system, partnership working between commissioners, prisons and healthcare providers has enabled the spread of the virus to be well controlled. This joint working has strengthened partnerships, which will promote closer working in the future.

But the challenge we set out is still present. While we have seen some examples of good collaboration in response to the crisis, it has not been evident everywhere and barriers to effective system working have been clear. Governance structures, leadership, working relationships, communication and finance remain key factors in the development and implementation of system working.

As the health and care system continues to wrestle with the pandemic, providers, regulators and system partners need to maintain the appetite to work together and at pace. We must make sure that we learn from the response to the crisis, that we lock in positive changes, and that we drive a new way of working that is supported at a national, regional and local level by the whole health and care system. The way we plan, commission and deliver health and care must be shaped by the experience of dealing with a national health emergency, which has shown so very clearly how interdependent health and care truly are.

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