From place-based to place-led: a whole-area approach to integrating care systems

Based on interviews with senior leaders, it seeks to provide further insight into how local systems can make progress in designing and delivering place-based, integrated care. In particular, it describes what system leaders can do to make this happen.

Key points

• A key enabler for place-based working is having a clear framework and set of guiding principles for the scope of work and decision making at each level of the wider system.
• Place-based partnerships often start with a ‘coalition of the willing’, with local government playing an important leadership role.
• To help local partnerships withstand the pressures and pace of change, many local places are investing in development programmes to strengthen relationships and expand leadership capacity.
• Effective place-based leaders are moving their thinking beyond the integration of health and social care to develop a shared understanding of their combined resources and assets, and then are using this as the basis for joint action.
• As they implement their long-term plans, local leaders are managing simultaneously to balance the needs of the whole population with the aim of delivering better care to individuals.
• Good governance is undoubtedly fundamental to place-based working. Places that are more rapidly progressing their plans are avoiding becoming distracted by rigid, bureaucratic and top-down governance structures.
• Although early days, local partners are learning to accept responsibility for the overall financial position of the place. Different approaches to contracting are being used to move away from the perverse incentives of a tariff-based payment system.
• Local places are involving local citizens and communities in different ways in the governance and decision making, but all consider this involvement integral to the delivery of local plans. .
• Having a core group of highly skilled and experienced staff to support the local partnership enables place-based working and the delivery of the local ambition.

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With thanks to the Social Care Institute for Excellence (SCIE), who helped to develop this paper.