Challenge

North East Lincolnshire Council and the North East Lincolnshire Clinical Commissioning Group have worked together closely to deliver health and care services for the past decade. The organisations have now made the decision to integrate as The Union to create a seamless health and social care service to grow and enhance North East Lincolnshire to improve the health, care and life experiences of residents.

FutureGov is supporting The Union to design a future operating model, setting the standard for the future of decision making, culture, technology and organisational design. Facing unique challenges, we’re seeking to transform two organisations to allow for the maximum integration possible whilst remaining separate entities, reconciling democratic and clinical governance and ultimately, best serving the needs of the population.

Approach

Focusing our discovery around the organisation structure, we identified categories for organisational improvement, developing the organisation before looking at service-level improvements: vision and strategy, commissioning and contracts, and data and insights.

Working in multidisciplinary teams, we worked in an agile way, guiding them through a design process from ideation to prototyping and testing, looking at each area of change to begin prototyping solutions that will help us build a 21st-century approach to seamless health and social care.

Vision and strategy

The discovery revealed strategic priorities within The Union were inconsistent and not widely communicated, making it hard for teams to resource and deliver effectively and collaboratively. We tested a set of coherent priorities to see whether these would impact a team’s ability to work effectively.

Collaboratively drafting a set of principles we learnt that these alone do not help with prioritisation. Principles need to be aligned to a clear delivery and resourcing model and to the budget setting process. However, principles can be used to decide what work is the responsibility of The Union and what sits in a single organisation of Council or CCG, allowing for better alignment of corporate change (Finance, HR etc.) with the vision and mission of The Union.

Commissioning & contracts

Inconsistent contract visibility and collaboration means the current commissioning process does not support collaboration or alignment to deliver on outcome-based commissioning. Creating visibility across contracts, aligning outcomes and timing of delivery, being holistic and strategic when commissioning, can enhance opportunities and reduce risks.

The quality of provider/commissioner relationships is fundamental to outcomes-based commissioning. By building the foundation for a partnership relationship between providers and commissioners to incorporate a shared understanding, accountability, ways of working and team ethics, will mean a better environment for agreeing and delivering on outcome-based contracts.

Data and insights

Differences in the guidelines, access to and use of data across The Union impedes insight-led decision making and commissioning. Guidelines are often interpreted as rules and this restricts parameters for potential decisions. Generally, there’s a lot of data available, though most of it is quantitative. This data is not currently centralised or presentable. Decisions cannot be more nuanced without better insight and insight cannot be improved without a clearer process around data capture, more balance between qualitative and quantitative and improved methods of presentation.

So far, we’ve run data tests including:

• gathering and sharing data in a multidisciplinary team across The Union
• identifying ways to gather qualitative data and ways to identify gaps and fill them
• identifying ways to present and communicate data and insights to decision-makers
• decisions we would make vs decision that’s been made

2020 to present

We co-designed the Future Operating Model in North East Lincolnshire to help make the Union an insight-driven commissioning machine. As testing was about to begin the COVID-19 crisis began.

Our initial goal for testing was to uncover what worked and to test a business intelligence function. Alongside leadership, we agreed that North East Lincolnshire’s COVID response had tested the approach we were working towards, on a large scale.

Approach

Instead of prototyping specific projects originally planned for phase 2, we turned focus on accelerating our approach to business intelligence. To do so, we focused on data and insights, working with The Union’s partners and sustaining change.

Data and insights

Working with the VCS on insights into social isolation, we began creating and learning from a joint data and insights function for The Union.

Research showed we need both qualitative and quantitative leadership and expertise, such as data analysis and data science capabilities combined with user research, design and delivery. This combined expertise can help us fully understand priorities for the Union.

Working together will only be successful if there’s a commitment from both the Council and CCG to shared resourcing and adopting new ways of working.

Sustaining change

The COVID response in North East Lincolnshire proved the council and CCG are already applying the new operating model together, working collaboratively with clear priorities. This cooperation has also continued at the team level over the past few months.

We’ve seen that The Union needs dedicated resources to make the model work long term and teams need a clear authorising environment to work in this new way. To support this we did two things: firstly, we designed a Change Playbook that can be used and adopted by teams across the Union to give them a clear and consistent way of delivery change; secondly, we have supported the design and recruitment of new roles to make sure that the Union have the right skills and capabilities to increase the impact they have in the future.

Impact

Future Operating Model: Beta test

Together, we’ve designed a Future Operating Model that we’re confident will transform efficacy and impact within The Union based on our tests and proposals.

We’ve detailed a six-month Beta test of the Future Operating Model, which is a reflection of the structure, skills and associated investment required to implement this model. This process will encourage further learnings about our approach and enable us to move into full-scale organisational change with greater certainty. The Beta test will take one or two areas of work through the full Operating Model cycle, from prioritisation through discovery, commissioning and if possible, management and learning.

The intended outcomes of the Future Operating Model are that:

• we’re clear about what the Union does and our role within it
• our decisions are made confidently and effectively and are aligned to the Union’s goals
• our commissioning is based upon evidenced need and strategic decision making
• we’re focused on the ongoing transformation
• we use our resources effectively and efficiently
• The Union through the CCG and NELC is an aspirational place of work

Alongside the Beta test, we’re recommending in-depth skills and capacity audit across NELC and NELCCG. This process will help us understand the existing internal capacity available to populate new roles within the Union, as well as the impact this has on BAU work that will remain within the remit of NELC or NELCCG.

Next steps

Following research into social isolation data we considered different options for how to organise data and insights skills and capabilities for the Union, with varying levels of integration between the Council and CCG.