Abstract
Introduction: Integrating health and social care has been a longstanding policy aspiration in England. This pursuit has been influenced by various policies including the Care Act 2014 which calls for integration of services by emphasising to consider strengths of individuals and leveraging individual and community assets when delivering services. This paper examines the implementation of one such strengths-based approach namely, Community Led Support (CLS) in two localities in England. Particularly, we study the conceptualisation of ‘community’, undertaking of co-production from the perspective of both sites and, the implementation approach to CLS adopted, site 1 led by an NHS trust and site 2, by a local authority. This comparative study is part of a wider study examining the implementation of CLS in five sites in England.
Engagement: The study was guided by a practice group consisting of various professionals from five sites as well as a lived experience advisory group. The lived experience advisory group played a pivotal role in offering support and constructive feedback- reviewing study plans, making suggestions, and participating in discussions about research findings.
Methodology:We adopted a case study approach drawing on 17 theory of change interviews with various professional groups involved in CLS in both sites. Interviews were analysed thematically.
Results: In both sites, ‘community’ encompassed residents in the locality regardless of care needs, community organisations and physical spaces where individuals interacted. In site 1, there was a tendency to focus more on ‘individuals’ and their ‘partnerships as part of the community while in site 2, there was greater emphasis on viewing community organisations as an integral part of community. While co-production is a core principle of CLS, it was often seen as an activity in both sites that lacked clarity on its specific components and operationalisation. Outsourcing co-production activities, whether formally or informally in both sites, appeared to underscore the significance attached to co-production.
There were some similarities in the implementation approach in both sites - operationalising CLS through community hubs, undertaking pilots before a full rollout and setting up of a senior leadership steering group to guide implementation. Both sites adopted a top-down implementation approach with limited initial input from external agencies. Although in site two, opportunities were created to develop leadership skills of frontline staff. Staff in both sites expressed anxieties about working in new ways but tailored training opportunities helped build confidence and foster a shared understanding about CLS. CLS was implemented on existing infrastructure.
Discussion: Both sites are yet to fully embrace CLS principles, leaving notable gaps in implementation. For successful integration and implementation, organisations should adopt a whole system approach that meaningfully involves partners and individuals with lived experience. Outsourcing co-production to those with more accessible community connections can be helpful but, may create gaps in understanding the needs of people. While top-down leadership sets the vision, CLS sustainability benefits when leadership skills of staff at all levels and, of community members are developed.