AREAS LEADING THE way in integration have worked hard to develop positive working relationships and a level of trust that was pivotal in joint working. Kirklees, supported by EY,  engaged in a focused programme to stepchange the way commissioning operated locally. They have found the investment has been wholly worth it in terms of their programme of change.

Bear in mind that this was at a time when turbulence in the NHS was at its height. The emerging CCGs were beginning to get a sense of detailed responsibilities. Engaging early (even before formal existence!) was critical to the success of the subsequent whole system approach.

Getting the nuts and bolts right was key. Mapping arrangements across the system flushed out differences in the description and delivery of commissioning activities. Developing a common understanding with a shared language proved to be an important foundation in later work.

By early 2013, the council was talking in concrete terms with the CCGs about intentions to secure commissioning capacity. This led to some joint appointments and constructive discussions with the CSU regarding their role. There was a desire to focus arrangements locally, given the priority of services in scope. By the time the CCGs came into formal existence, a description of system-wide commissioning; areas of collaborative activity and joint priorities was formed which would later develop into a work programme.

In order to secure working arrangements, an MOU was drafted and painstakingly approved through the council and CCG Boards and the Health and Wellbeing Board. This was time-consuming, but critical to building confidence among decision makers.

Throughout the last 18 months, agencies have been wrestling with budget challenges and provider reconfiguration. The groundwork has meant that issues can be tackled together. Because of all the work done to build relationships; because of the mechanisms developed; because of all that painstaking attention to detail describing how things will be done, Kirklees can be agile in how they respond to challenges. While the whole system is facing extraordinary circumstances, Kirklees have a better chance than ever before of getting this right. We have a way of working, the money is on the table and we have a plan.

If you would like to know more about the Kirklees journey, other perspectives on making integration work locally, and engage in the debate - please visit us at Speakers Corners at the NCAS conference

Alison O'Sullivan
Director for Children and Adults

Helen Sunderland, Social Care Lead
Assistant Director, EY