Co-production of a new ICB operating model for Surrey Heartlands

In anticipation of transition to a statutory Integrated Care Board, Surrey Heartlands ICS Executive commissioned a partnership of the TU and Prospect Business Consulting to support co-production of a new ICB operating model.

Our innovative approach sought to align a programme of executive leadership and organisational development alongside the co-production of the new operating model. Wide-scale, cross-sector stakeholder involvement ensured local ownership and strong progress in building and evolving working relationships between system partners. Embedding an operating model toolkit has enabled self-sufficiency within the system to continue to evolve and expand the operating model development.

The Challenge

As a relatively mature ICS, Surrey Heartlands had made excellent progress in advancing their Places and working collaboratively. However, they recognised the need to further mature their thinking around how best to apply the principle of subsidiarity so that they could empower their four Places to design and deliver care that best meets the needs of their population. They also wanted to maximise opportunities to work at scale, where appropriate, to enable them to tackle health inequalities, create a sustainable and resilient health and care system and drive digital integration.

With no ICS having yet transitioned or having developed their operating model there was no precedent or blueprint to follow. This work was also set against a backdrop of a CCG staff restructure, surge of the omicron COVID-19 variant as well as the need to keep pace with emerging legislation, policy and guidance.

Our Approach

Recognising that we were working within an innovation space, the agreed approach sought to employ tried and tested methods for developing an operating model from the worlds of manufacturing and business. The approach was tailored in accordance with the ICS design guidance. The work programme comprised:

1. an initial phase of executive leadership team development, building the standardised methodology, agreeing design principles, determining staff development needs and creating an OM development toolkit (including tools for future state mapping, capability mapping and a subsidiarity framework).
2. a development phase where leads for each of the functions were supported to engage stakeholders, deliver co-design workshops and to use the OM development toolkit in a standardised way. The operating model for each function was documented into a standardised template.
3. a convergence phase where interdependencies between the operating models for each function were mapped, a whole ICB operating model was assembled and an initial implementation plan was developed.

The Outcome

Fifteen functional workstreams were supported to work collaboratively with a broad range of stakeholders from across the system to produce their individual operating models. Interdependencies were subsequently mapped and the whole ICB operating model assembled.

Functions included in the operating model are: Clinical Leadership, Commissioning & Contracting, Communications & Engagement, Digital, Data & Technology, Facilities & Estates, Financial Recovery, Governance & Assurance, Information Governance, Multi-professional Leadership, People & Culture, Place-making, Provider Collaboration, Quality, Strategy & Transformation, System Resilience (System Coordination Centre).

The resulting operating model was designed so that:

• Places, Neighbourhoods and Collaboratives are empowered to: understand and prioritise their local population health needs; design and deliver services and the wider offer to meet population health needs; innovate and improve services; build partnerships across their local communities; work together where there is need to work at scale or for one Place to lead on behalf of the others
• The principle of subsidiarity is fully embedded, but work is undertaken at system scale where this provides benefits or best enables leaders to create capacity or manage risk/dependencies.
• The success of the system is dependent upon all of its component parts – all of the partners, providers, Places, neighbourhoods, collaboratives and communities matter and will be key to realising their ambitions

Implementation of the operating model has now transitioned into ‘business as usual’ arrangements for each of the functions. The operating model is expected to evolve as additional ICB duties are delegated, further policy and guidance emerges and their strategy and priorities develop. Future developments may also expand to include the Integrated Care Partnership functions.