Symphony Project

The Symphony Project was set up to integrate health and social care in South Somerset. Somerset CCG and local partners together defined the ambition to “dramatically improve the way in which health and social care is delivered in South Somerset”.  LH Alliances was engaged in 2013 to provide alliance expertise and facilitation as a delivery partner for the significant change programme to be undertaken.

Why alliancing was chosen

Apart from a shared ambition to design a new more integrated care model there was also recognition for the need for a new approach to working together. The partners set the ambition to adopt alliance contracting, because it embodied the collaborative spirit which the project has been built upon.

Key components of the Symphony Project in 2012-2014

  • Evidence – individual level data on current health and care activity for those living in South Somerset
  • Shared outcomes – a single set of outcome representing value to all
  • Alliance contract – a collaborative contracting and financial approach
  • Primary care – involvement of primary care throughout all stages
  • Care model – an innovative, person centred care model to deliver the outcomes

Creating the alliance

Throughout 2013 and 2014 the Symphony Project brought together all partners to develop the outcomes, design the new care model and consider shared agendas and aspirations.

In August 2014 a decision was made to pause the alliance contract development. The outcomes and performance framework and design principles went forward to shape the implementation of Expert Care Hubs in South Somerset.

What changed for people

The first Expert Care Hub is being operationalised and Somerset is now a Vanguard site. Evaluation of the impact on those who use the new services is being undertaken. We will provide links when they become available.

Our approach

LH Alliances was brought in for our expertise on developing outcome frameworks and alliance contracting. Key to our role was to facilitate the process of alignment and identification of misalignments.

We worked intensively with the programme director and several workstream leads in advising and facilitating their work. We pride ourselves in our flexibility and adapted to change programme advisory and support as well as the alliance development.

Although the project did not proceed to an alliance contract we contributed to the outcome set and the design principles which have been taken forward into the continuing work of the Symphony Project.

Read more by clicking on LH Alliances Input below.

“Linda Hutchinson joined the Symphony Programme at an early stage. Although her initial brief was to help us create an alliance contract she was prepared to roll her sleeves up and help us with a range of developments across the programme. She understood the local issues and helped structure our thinking and approach. With her facilitation, we identified critical issues for implementation, which we were then able to address.  Her support to me as Programme Director was invaluable. I would recommend her as a delivery partner for anyone embarking on complex integrated care development.”

Jeremy Martin, Symphony Project Director

Development of the Alliance

Readiness

An extensive data analysis to provide the baseline for the funding envelope and business case was undertaken by the Centre for Health Economics at York University. It allowed a robust understanding of current patterns of utilisation and cost for target groups. This strong ethos of using evidence was a feature of the Symphony Project.

The first cohort of patients to be offered the new model was agreed after review of the evidence.

In readiness for a potential alliance contract it was important commissioner had a strong set of outcomes that represented value to patients and the local community. An overall set of aims had been created in the early stages of the project. At our recommendation, a further series of engagement activity with people using services, frontline staff and partners was undertaken. This allowed a set of outcomes that represented value to these groups to be developed. Further work was then undertaken by a cross organisational group led by a GP to develop measures and collection methods to track performance against the outcomes.

Alignment

The proposed members of the Symphony Alliance  were

Throughout the alignment sessions there was a strong sense of wanting to achieve together and break down barriers. A specific focus in the sessions was on business drivers and potential commercial misalignments. The opportunity to positively drive change through an integrated care model is dependent on aligning the financial arrangements and payment mechanisms. However, it was recognised by the parties that changing these financial arrangements is potentially destabilising and needs to be carefully considered.

Following the alignment sessions a design team was set-up and tasked with design of a care model that would deliver the outcomes.

Design

The design team, led by a GP, developed the new care model. An economic case was developed for the new emerging care model.

In parallel, conversations continued on the potential new financial arrangements and funding flows to support the principle of money following activity. A plan was developed to move into an alliance governance structure in shadow form initially, to make the shift to collaborative decision-making with all members of the alliance taking responsibility for those decisions. This raised issues of providers’ commitment to collaboration when there was an absence of detail on financial arrangement.

Implementation

As the programme moved to implement the new service model a decision was made to re-look at the proposed alliance approach. In August 2014 the Symphony Project Board decided to pause full implementation of the alliance, to take time to resolve any degree of uncertainty for the partners first.

Since then, some of the key features of the Symphony care model have been implemented. An Expert Care Hub, one of the key features of the new service model opened at Yeovil District Hospital.

LH Alliances input

Our role during our engagement was wide ranging. It included:

Advisory

  • Advising and coaching the programme director in leading a whole system change programme in health and social care
  • Advising on governance of an alliance to deliver an integrated system
  • Assisting with developing options for funding and financial flows
  • Bridging the analytics through to the outcomes and Key Performance Indicators (KPIs) to inform commercial arrangements and advising the outcome workstream chair to create the detailed KPIs.
  • Advising on design brief to meet the outcomes and ambitions of the programme

Facilitation 

  • Conducting information sessions on alliancing for senior executives, local organisations and  GP community
  • Ensuring a shared vision and strong mandate that represents value from all perspectives – patients, families and carers, public, frontline staff, providers and commissioners
  • Facilitation of outcome set development based on the above and translating these into a performance framework for future use
  • Facilitation of alignment workshops with senior leaders to set the principles by which they wanted to behave and to harness value creation between the parties

Delivery

  • Liaising with Monitor and arranging Symphony presentation at the London facilitation officers – providing access to our network of national organisations
  • Sourcing programme management and other external bodies in support of the programme

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