2. Approach to improvement support

Support has been offered across three tiers:

1. Universal: Accessible to all systems to use as they see fit. This includes self-assessment tools such as our flagship High Impact Change Models, virtual seminars and workshops, or good practice publications.
2. Targeted: Locally offered and suitable for adaptation, but with a standard offer based on evidence of what works.
3. Bespoke: Individually designed with the system being supported, most often around service review, design and implementation.

Proposals for all bespoke, targeted and universal support offers were submitted to funding partners for approval prior to delivery, evidencing need and setting an appropriate budget. 72 per cent of local system support has been directed by funding partners, and 28 has been demand-led. The Programme worked to try and map other support activities being provided in the system, to ensure alignment and avoid duplication.

An essential factor in determining whether a system receives support through the Programme is a ‘system readiness’ check to gauge how aligned and receptive the system is to external facilitation and improvement support input. Our insights suggest that sustained improvement has the best chance of succeeding when system leaders are aligned around a shared purpose, demonstrate collective ownership of the work, and have the supporting infrastructure and governance mechanisms firmly in place. Where a system is having challenges and colleagues are not yet aligned on this, the Programme has offered scoping diagnostic support. This brings system leaders together, in a session facilitated by an external expert, to reach consensus on shared priorities and support required to address them.

The Programme also established a robust model for introducing appropriate and timely expert input into health and social care systems. Procurement of expert support by the Programme saves time and resources for local systems. Systems have had the opportunity to contribute to the selection of the contractor who will be working with them, without the burdens of contracting processes and market management. The Programme closely manage and quality assures the work of contractors, providing assurance to national funding partners that where the sector is turning to procuring external support, it is providing value for money.

When support is complete, the Programme provides a detailed report of findings and recommendations to local system colleagues. In line with sector-led principles, this is for the sole use of the system. To summarise outcomes, share learning and provide evaluation of the support, an End of Support Report is also produced, signed off by the local system for sharing with funding partners and wider.

To reflect the Programme’s core aim of strengthening integrated ways of working, our improvement support offer requires systems to identify either two Senior Responsible Officers (SROs), one from health and one from social care or a jointly agreed SRO, to oversee delivery and facilitate co-ordination of activity across the system. The support engages with staff from partner organisations across the local health and social care system, from leadership through to the front-line.

As the first contract of its kind, there has been learning from all Support Programme partners about the best ways to collaborate in delivering improvement support to health and social care systems. The BCF Support Programme team has worked closely with colleagues nationally and regionally. The relationships built with regional NHSE teams, Better Care Managers (BCMs), Care and Health Improvement Advisers (CHIAs), and ADASS has enhanced the understanding of whole system support needs in shaping the offer. The team has liaised productively with DHSC policy teams and NHSE teams such as on the development the High Impact Change Models for Dementia and Delirium and Using Data for Decision Support, has established a fortnightly catch-up with the NHSE Emergency Care Improvement Support Team (ECIST) to share intelligence and avoid overlap and duplication of support work when in local systems, and has collaborated with other national partners such as NHS Confederation.

The Programme works with the Discharge Support and Oversight Group (DSOG), now the Discharge and Admissions Group (DAG), which facilitates joined up working between DHSC, NHSE and local authorities, and informs Programme priorities. LGA/ADASS representatives from the BCF Support Programme attend the weekly DAG meetings. When a system is onboarded for DAG support, they are offered the opportunity to have access to support via the Programme. Additionally, expert colleagues who sit on DAG can submit a system for targeted support if it was felt that this would benefit the system, such as the Care Transfer Hub improvement offer to three local systems.

Responsiveness to evolving policy priorities was built into the Programme. The team met weekly with funding partners to discuss emerging issues in live projects and potential new support requirements. A Programme Tracker developed early on in the contract is shared fortnightly with funders, CHIAs and BCMs to ensure all partners are sighted.

The Programme has also been responsive to system and sector needs. Members of the team meet routinely with contractors and system colleagues, making it possible for support to be adjusted as circumstances change. In other cases, support has been successfully steered through significant changes in local system personnel. Work is designed with key local deadlines in mind, such as relevant Board meetings.

A Quality Assurance Framework has been developed to enable the support offered by the Programme to undergo continuous improvement. This allows the team to monitor risks such as delays or scope creep, escalating as appropriate, and learn from feedback from system colleagues. The same approach has been applied to online events, with sessions being organised featuring case studies of good practice based on attendee feedback, and more time included for Q&A.

Working Partnership with DSOG/DAG

DSOG, now DAG, was set up to drive improvement by ensuring engagement with the right local systems – at the right time – to understand their plans and performance, provide challenge, either target or broker improvement support, spread good practice and innovation, and help resolve systemic barriers that have been identified.

The approach of DAG has been informed by Programme learning on system readiness. We have learnt that in addition to DAG identifying that improvement support would be helpful for a system, the readiness, willingness and capacity of the system to engage with the support are important factors to the support being delivered successfully. We have also learnt that if there are multiple support offers being delivered in a system by different agencies and organisations, it can overwhelm system colleagues and impede engagement.

Intelligence from support projects has been flagged at weekly DAG meetings, and End of Support reports are referred to ahead of DAG calls with systems to provide a well-rounded view of what is happening locally.

Working Partnership with the National Better Care Fund (BCF) Team

The National BCF Team oversees the implementation and delivery of local area BCF plans. The purpose of the National BCF team is to support local systems to successfully deliver their BCF plans and ultimately commission person-centred health and social care services which achieve improved patient and service user experience and outcomes. The National team also supports national partners to develop and implement policy on health and social care integration.

As part of its work, the National BCF team undertook a Planning and Assurance (P&A) survey to obtain feedback, learning and insight, from health and social care systems, in order to strengthen system readiness for the next round of BCF planning and assurance. This was undertaken to further develop in-year reporting and to help inform how to support systems in the most effective way. The survey went live from 29 July 2024 to 30 August 2024, identifying a range of common improvement themes, enablers and emerging recommendations from systems (provided via BCF leads in systems). To complement this, feedback was also gathered from Better Care Managers who provided a range of ideas for improving the P&A process.