Designing the future operating model of the Union

Challenge

North East Lincolnshire Council and the North East Lincolnshire Clinical Commissioning Group have worked together closely to deliver health and care services for the past decade. The organisations have now made the decision to integrate as the Union to create a seamless health and social care service and improve the health, care and life experiences of residents.

We supported the Union to design a Future Operating Model, setting the standard for decision making, culture, technology and organisational design. Facing unique challenges, we worked to transform two organisations to allow for the maximum integration possible whilst remaining separate entities, reconciling democratic and clinical governance and ultimately, best serving the needs of the population.

Solution 

Focusing on organisation structure, we found areas for organisational improvement. We then looked at service level improvements across vision and strategy, commissioning and contracts, and data and insights.

Vision and strategy

Strategic priorities within the Union were inconsistent and not widely communicated, making it hard for teams to resource and deliver effectively and collaboratively. Collaboratively drafting a set of principles we learnt alone does not help with prioritisation. However, principles can be used to decide what work is the responsibility of the Union and what sits in a single organisation of the council or CCG.

Commissioning and contracts

Inconsistent contract visibility meant the existing commissioning process did not support collaboration. Creating visibility across contracts, aligning outcomes and timing of delivery, and being holistic and strategic when commissioning can enhance opportunities and reduce risks. 

Data and insights

Differences in the guidelines, access to and use of data across the Union prevented insight led decision making and commissioning. Generally, there was a lot of data available, but it was not centralised or presentable. We, therefore, investigated how to:

• gather and share data in a multidisciplinary team across the Union
• gather qualitative data and ways to identify gaps and fill them 
• present and communicate data and insights to decision-makers

We co-designed the Future Operating Model in North East Lincolnshire to help make the Union an insight-driven commissioning machine. As testing was about to begin the Covid-19 crisis began.

Alongside leadership, we agreed that North East Lincolnshire’s Covid-19 response had tested the approach we were working towards, on a large scale with clear priorities. We saw that the Union needs dedicated resources to make the model work long term and teams need a clear authorising environment to work in this new way. 

To support this we did two things: firstly, we designed a Change Playbook that can be used and adopted by teams across the Union to give them a clear and consistent way of delivery change. Secondly, we supported the design and recruitment of new roles to make sure that the Union has the right skills and capabilities to increase the impact they have in the future.

Impact

Together, we designed a Future Operating Model that we’re confident will transform efficacy and impact within the Union based on our tests and proposals. 

We detailed a six month Beta test of the Future Operating Model, which is a reflection of the structure, skills and associated investment required to implement this model. This process will encourage further learnings about our approach and enable us to move into full-scale organisational change. The Beta test will take one or two areas of work through the full Operating Model cycle, from prioritisation through discovery, commissioning and if possible, management and learning.

Overview of the Future Operating Model

Alongside the Beta test, we recommended in depth skills and capacity audit across NELC and NELCCG. This process will help us understand the existing internal capacity available to populate new roles within the Union, as well as the effect this has on business as usual work that will remain within the remit of NELC or the CCG.