In 2021 we marked the 14th year that PPL has been supporting the development of person and community-centred care across the UK, working with local authorities; NHS commissioners; acute, community, mental health and social care providers; GPs; and voluntary and community sector providers, as partners in delivering better integrated care.

Despite all of the work in this area, we know that many people continue to experience dis-integrated care and that pressures on local services and communities continue to grow. The following are some of the key lessons from our recent work.

1. It’s all about people

There has been significant investment and advancement in areas such as Population Health Management as ways to better understand, predict and respond to local needs. Such data and techniques can be enormously powerful but are no substitute for understanding the diversity, wants and needs of the individuals who make up our organisations, systems and communities. Early, broad and authentic conversations are key to understanding why ‘when we all want to do a good job’ such positive intentions often fail, to overcome the barriers to better ways of working and to deliver real improvements in people’s health and wellbeing.

2. A shared vision is not enough

We have been talking about integration within and across health and care services for long enough that most people who are involved in local partnership development can articulate strong and similar visions for what ‘good’ might look like. However, without a clear narrative that connects this vision to the daily experiences of patients, carers, service users and frontline professionals that explains how tomorrow is going to come to the aid of today it is likely to remain just that, a vision of what could have been, always just out-of-reach. Through co-designing a clear and specific narrative built around lived experience, we can help establish a clear roadmap based on the priorities and outcomes that matter to people’s lives, and the broad coalitions that are needed to deliver.

3. Working in partnership is hard

The pandemic has seen a step-change in the way in which we work and how all those involved in health and care have engaged with each other, with voluntary and community sector partners, and with communities themselves. However, we can already see how the pressures on individuals and organisations are starting to re-assert themselves and how they threaten some of the shared purpose and ways of working that have developed in this period. Whilst there are huge benefits to working in partnership, we must also recognise the costs and the importance of being able to resolve conflicts, negotiate complexity, make and implement joint decisions, and share risks and rewards. The most robustly-structured partnership agreements are no substitute for developing a culture of joint working that extends beyond the exceptional leaders that often sit at the heart of the best of our current integrated care systems. Empowering people to acknowledge the challenges and to work through them will help them achieve the benefits of better integrated care.

4. Build to scale

There is nothing wrong with starting small and it is critical that partnerships can evidence the benefits of people working differently, be that in delivering ‘quick-wins’ for local people or through prototyping new ways of working that show the possibilities of change. However, too many of our partnerships stall at this stage, establishing ‘walled gardens’ where we feel comfortable working together whilst most people’s experiences of care remain unchanged. Scaling means having in place the shared governance, infrastructure, funding and organisational development to enable the many to benefit from integration, not just the few.

5. It’s still all about people

For too long, our partnerships have been structured around statutory institutions and a belief that, if only they can construct the right ‘pathways’ of care, then better outcomes will follow. The experience of Covid-19 has been a painful reminder of the terrible effects of inequalities on people’s health and wellbeing, the vital role people play in their own health and care outcomes, and the impact of failing to hear what people are saying they need from local services. Only through effective and ongoing community engagement and empowerment will we achieve real and lasting improvements in people’s health and wellbeing and, in turn, ensure our health and care systems are sustainable for the generations to come.