The purpose of this paper is to report the findings of a horizontal integration programme in the South West of England. The programme was unusual insofar as it included the full range of public services being provided in a single town. It was a place-based system framed by the concept that a person’s wellbeing includes their health, economic status and living environment and that they are inextricably linked. As well as aiming for broader system integration, the programme utilised a person-centred approach using service-user perceptions to influence design. It was implemented through a local governance structure using a set of collaborative principles.
The paper presents personal reflections of the programme manager about the efficacy of the model, its sustainability and the problems encountered. It sets out the principles defining the model and the extent to which the principles were followed in practice.
Creating a holistic public service based on integration to tackle deep seated problems within a population requires reducing complexity at the interface between citizens and services. A local system model that includes all public services allows for collective responsibility for meeting the service needs of the population augmenting the connections and bridging the gaps between services. There was a recognition amongst participants that service redesign does not require wholesale organisational restructuring but does require creating shared aims and objectives and the participation of leaders with the ability to implement change within their services. A user-led, bottom-up approach provides deeper understanding and traction on the ground but should be combined with top-down strategic support to provide structural sustainability and the ability to scale out.
The paper demonstrates that horizontal service integration based on the concept of wellbeing is possible but faces significant challenges. The benefits and complexities of inter-agency collaboration multiply when enhancing the outcome focus from improving population health to general wellbeing. New theories of implementation and transformation are needed that relate to this important emerging service theme.
The author is grateful to the following people for the helpful comments received whilst preparing this paper: Dr Andrew Moore, Consultant Psychiatrist, Devon Partnership NHS Trust; Martin R White, Health and Wellbeing Programme Manager, Public Health England South West; Neil Blackburn, Head of Central Operations, Devon and Somerset Fire and Rescue Service; and Jeremy Mann, Head of Environmental Health and Housing, North Devon Council.
Beacham, A. (2017), "One Ilfracombe: Piecing together the public sector puzzle using a person-centred, local system approach", Journal of Integrated Care, Vol. 25 No. 3, pp. 150-161. https://doi.org/10.1108/JICA-10-2016-0038Download as .RIS
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