Our involvement with the Nuffield Trust, participation in the listening exercise and in the newly convened ‘Integrated Care Discovery Community’ here in the northwest, has given us opportunities to meet with and hear from other health economies with a desire to integrate.

For the Trafford health economy this has been both reassuring and frustrating: reassuring because we can see other health systems adopting similar principles and striving for the same outcomes; frustrating because others seem to have been able to mobilise some aspects much more easily and at much greater pace than we have achieved.  We need to reflect on the factors that may be at play in our health economy.

It is only with better knowledge of the skills and competencies of others involved in the care of patients that we can share the risk and gain the benefits of integration

Integration should mean different things and have different priorities in different places but there are some common fundamentals.  Leadership, both clinical and organisational, is key and needs to have strength and stamina because these developments will take time and will require continual refinement to be sustainable in the long term.

We embarked on a programme of clinical engagement events before we committed the health economy. The development of the principles and vision then came from subsequent events involving clinicians, managers and patients. That shared commitment has helped sustain us through some difficult times.

We have continued that engagement with the development of a training programme to combine quality improvement and leadership that sets a cultural tone for the system and is delivered to multi-agency and multi-disciplinary groups.

We have set out to step across the traditional boundaries and bring together commissioners, providers, primary care and secondary care, social care and the local people to engage in setting the vision and agreeing the changes that are needed.

A consequence of taking this approach had been the establishment of new relationships and the development of trust and confidence between individuals and organisations. It is only with better knowledge of the skills and competencies of others involved in the care of patients that we can share the risk and gain the benefits of integration. This improved understanding has been the single most important thing that has developed in Trafford.

We have bravery and commitment in abundance locally. What we need from the centre is a clear indication that when health economies are brave and bold that they can be given space, time and support to implement the radical changes that integration inevitably requires.

An NHS fit for the future needs to evolve. Evolutionary change is based on variation. New ways of working need to be encouraged that can adapt to meet the health and social care challenges ahead.