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The paper seeks to move the integrated care debate forward by exploring what contributes to improved quality and efficiency, and to consider the practical consequences of translating a model exemplifying that success into the English context.

The authors contend that a key driver is to unite the whole system in a single purpose, incentivising all parts to align with that single shared purpose. Although designed for a very different healthcare system, the Accountable Care Organisation (ACO) model exemplifies this principle – aligning incentives across a variety of providers to achieve practical integration driven by outcomes.

The authors explore what an ACO model would comprise if transposed, demonstrating that it offers the short term gains claimed for integrated care whilst also providing a structured framework setting out a clear long term roadmap for both commissioner and provider evolution, hitherto not addressed by policy. Drawing analogies from other industries it is suggested that potential conflict between integration, competition and choice is exaggerated. The discussions with leaders and whole community groups has consistently been found to provide fresh and helpful insight.

In this paper, the authors bring fresh insight to what aspects of integrated care contribute to future success and then explore why and how that insight can be applied by translating growing experience from elsewhere into the English NHS setting.

This paper aims to report on the approach to change used in the development of a tool to assess patient status six months after stroke (the Greater Manchester Stroke Assessment Tool: GM-SAT).

The overall approach to change is based on the Promoting Action on Research Implementation in Health Services (PARiHS) Framework, which involves extensive stakeholder engagement before implementation. A key feature was the use of a facilitator without previous clinical experience.

The active process of change involved a range of stakeholders – commissioners, patients and professionals – as well as review of published research evidence. The result of this process was the creation of the GM-SAT.

The details of the decision processes within the tool included a range of perspectives; the process of localisation led commissioners to identify gaps in care provision as well as learning from others in terms of how services might be provided and organised. The facilitator role was key at all stages in bringing together the wide range of perspectives; the relatively neutral perceived status of the facilitator enabled resistance to change to be minimised.

The output of this project, the GM-SAT, has the potential to significantly improve patients' physical, psychological and social outcomes and optimise their quality of life. This will be explored further in future phases of work.

A structured process of change which included multiple stakeholder involvement throughout, localisation of approaches and a dedicated independent facilitator role was effective in achieving the development of a useful tool (GM-SAT).