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Successful integration relies on clarity of purpose

Jerry Clough
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There is a very interesting TED talk by Simon Sinek, based on his book, Start with Why, in which he advances the idea that the most successful companies, unsurprisingly including Apple, are those that are the clearest about their purpose.

In our journey towards an integrated health and wellbeing system in Plymouth, we have aimed for the most comprehensive target. In April 2015, at the same time as creating an integrated provider of adult health and social care through the community interest company, Livewell Southwest, we also started working as integrated commissioners. Our £640m single integrated commissioning fund brings together all health service commissioning in Plymouth with public health and all of Plymouth City Council’s spending on social care, community safety, education (including the direct schools grant), leisure, housing and homelessness.

It was driven by a bigger purpose; integration, however radical, is still only a description of how you organise services. We are working towards the future of Plymouth, ‘Britain’s Ocean City’. We know economic growth and prosperity is ultimately the way we will improve the poor outcomes and large inequalities that the most challenged communities in our city face.

Delt, the new IT company jointly owned by the council and Northern, Eastern and Western Devon Clinical Commissioning Group is a great example of focusing on purpose. It will save money and improve services, but its purpose is to protect high-paid, skilled jobs locally, rather than exporting them to a service provider based further afield.

If you get the ‘why’ clear, staff are more engaged and driving towards challenging goals is more straightforward. We have invested heavily in developing leaders and teams. Some of that is skilled facilitation - in our case using strengths-focused leadership - but most of it is giving time for people to meet for one day per month to build trust and relationships. Staff development has defined our programme. We have been co-located for some time as commissioners and have recently started appointing to a single management structure.

We have seen plenty of success. The adult social care budget was in balance in 2015-16; the integrated fund recorded joint benefits; and we have services in place that simply wouldn’t have existed before, but we very much see ourselves as being at the start of a journey

My personal highlight is that this month a new integrated service for young people has started in the city. Head teachers have pooled their money for emotional health and wellbeing across all the schools in Plymouth with health money for child and adolescent mental health services to create a joined up service that will offer so much more support, in a co-ordinated way, to those most in need. It is remarkable, inspiring and simple, and possible only because of the environment of co-operation and partnership that we have fostered.

Plymouth’s journey is not unique and others are several years ahead with some of the elements that we have put in place only relatively recently. However, the clarity of focus on a purpose and a determination to grow a new system with development support for relationships and behaviours does offer some insight.

Jerry Clough, chief operating officer, Northern, Eastern and Western Devon Clinical Commissioning Group

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