Principles, policy goals, and effectively balancing tensions within national integrated care programmes – understanding the Welsh Government’s Regional Integration Fund

Background: The Regional Integration Fund (RIF) is the Welsh national policy initiative designed to advance the government’s health and social care integration agenda. Yet it is trying to forge new ways of working and amend complex systems in real time, systems which are under significant strain and stress, which leads to tensions that need to be carefully managed if the Fund is to be successful.

 

Approach: This presentation will draw on evidence from the independent national evaluation of RIF. The study uses mixed-methods to derive insights that are aligned with the ‘Principles-Focused Evaluation’ (P-FE) approach (Patton 2018). The project is supported by the Study Co-Design Group, experts by experience and critical friends who comment on and shape our approach to understand the key P-FE questions.

 

The first of these questions (To what extent have meaningful and evaluable principles been articulated and understood?) is the focus of this presentation, and to provide an answer we draw on four supporting evidence papers: the Framework for Change (an overview of the aspirations for change and the contextual factors that impact RIF's implementation); a Realist literature review; an online consensus approach to understand the ‘design architecture’ of RIF; and in-depth scoping interviews with 24 key informants.

 

Results: From our evidence, a complex picture is emerging of the ways in which the principles associated with the integration of health and social care are being implemented. We argue that understanding how these concepts operate throughout RIF offers insights into how the underlying assumptions, ideas, and concepts of time-limited funding schemes as mechanisms for ‘transformation’ are realised (or not) in practice.

 

Building on similar approaches (see Haring et al. 2022), our analysis has identified six ‘pairs’ of ideas that are in some way in tension with each other at the heart of RIF, which speaks to the complexity of such schemes:

Alignment and Aspiration

Control and Collaboration

Fidelity and Flexibility

Accountability and Autonomy

Ownership and Partnership

Structure and Agency

 

Implications: It is in the exercise of effectively balancing these concepts that the success of RIF (and other similar schemes) will be determined. As elsewhere, RIF operates in a fast-changing policy and social context. The evidence collected to date raises questions about striking the best balance between what time-limited funds can achieve alongside the capacity for regional/local autonomy and flexibility.

 

These forces need to be balanced in order to plan and deliver improved outcomes through community-based care, ensuring there is sufficient diversity to reflect the changing needs and contexts of those communities. These tensions are not just particular to Wales. This paper is an attempt to map the contours of the challenges, dynamics and opportunities in using such funds for delivering change processes that might make a difference to communities over time.

 

References

Haring M et al. What can healthcare systems learn from looking at tensions in innovation processes? A systematic literature review. BMC Health Services Research. 2022; 22(1299).

Patton MQ. Principles-Focused Evaluation – The GUIDE. New York; Guilford Press; 2018.