Derbyshire Integrated Neighbourhood Teams

The neighbourhood

Neighbourhoods in this case study are defined as being co-terminus with district councils but can vary within this. There are eight district council areas within Derbyshire.

Districts can contain a population of 70,000 – 125,000 people.

The work of the INT covers several varied issues, both healthcare related but also wider civil society such as justice and policing. Assets can be mobilised as appropriate through a very broad group of neighbourhood stakeholders.

The context

Derbyshire Integrated Neighbourhood Teams are designed around improving population health, and are focused on improving broad determinants of health, civic life and building of communities.

The need for the model was born from a lack of capacity in primary and acute care settings,  and a necessity to work differently to reduce the demands on local services.

The work started with the National Ageing Well programme, with a focus on neighbourhood level pilots supporting older people to live well at home building on what existed locally and existing health and care infrastructure.

Since then, the work has grown to tackle a much broader scope, with support for frail elderly people still a key focus.

The model

The model uses a broad scope and a broad set of partners including primary care, adult social care, residents, VCSE, NHS trusts, national park, police and education representatives. The funding is secured through ICB budgets.

The partners form a local alliance that then reports into the ICB, representing a commissioning relationship that devolves responsibility from the ICB to a more local level.

The breadth of this group allows local alliances to tackle diverse issues including debt management, isolation and crime.

The local alliances are encouraged to produce solutions as a place or neighbourhood and define their own outcomes, culture and ways of working. The community ownership and agency is very strong in the model, which is a key to its success.

The system took a considered risk to take on this shift to more prevention-focused work rather than continued increased funding to more acute services – this was driven by a feeling that the current services were not, and could not, cope with existing demands and the current ways of working were unsustainable.

The model is strength-based and puts trust in a distributed leadership and partnership of organisations.

What makes this effective and resilient

Governance primarily sits within the ICB, reporting on outcomes and assurance flows through these channels. It is a strong example of how ICBs can be key drivers for integrated neighbourhood working.

However, a core part of ways of working is inclusion of community representatives in the governance structure represented in local alliances that report into the ICB.

Local leadership, including statutory leaders willing to shift to working differently in financially challenging circumstances, and local partner leaders willing to collaborate and align together in alliance contracts. This takes time to embed and high levels of trust.

The local alliances are both a source of action but a place where community knowledge and an understanding of community needs aggregates, providing an invaluable source of information.

Statutory bodies are now mandating that staff work with communities and VCSE because of the partnership working that has been established and the benefits they can see of working together. The model feels like the beginning of wider action and deeper relationships.

Social prescribers have been invaluable to the model, linking residents to statutory and non-statutory services and providing feedback to local alliances on community needs.

Budgets with very few strings attached allowed for flexibility to meet community needs.

Project management, in the form of full-time and dedicated workforce to drive change and integration has been vital to the effectiveness and sustainability of the model.

The local VCS alliance has been vital in bringing in VCSE groups, it would have been challenging to engage with these stakeholders without such a strong and effective alliance.

What makes this challenging

The expectation of seeing results in a short timeframe has been a challenge. Addressing multiple determinants of health and deep-seated problems does not deliver in a matter of weeks, it takes considerable time.

Still trying to navigate partners who work in silos by design, rather than those silos being designed out of organisations.

Navigating organisational cultures and the tendency of some organisations to retreat into their own organisations when activities become complicated.

Repurposing funding from acute providers when they have so many pressures themselves is a challenge – this takes a real belief in the process and its outcomes.

Governance processes across organisations having to unite has been a sticking point. This includes delays introduced by Integrated Neighbourhood Team decisions needing to be agreed through each partners’ governance in their host organisation before progress can be made.

Impact and outcomes

2,300 category 3 ambulance call outs avoided and reduced hospital stays by 1,400 through a specific pilot supporting frail patients in their homes

93 per cent of staff working in the service would recommend it as a place to work

Excellent qualitative and anecdotal evidence to suggest this is improving the health and wellbeing of neighbourhoods in Derbyshire.

It is challenging to separate the impact from the other things that occur at a neighbourhood and place level, nonetheless the ICB governance structure demands and expects reporting on progress.

“Thank you for making my mum so comfortable last week. The last days of her 98 years were filled with compassion and respect. She and I couldn’t have asked for more.” 
Resident