Resource allocation within and between INTs across London’s region, five systems, and associated place partnerships will be enabled by the following principles:

Resourcing will facilitate a move away from organisational siloes toward an expansive ‘team of teams’ way of working which can flexibly and holistically respond to changing needs in the community.

Our resourcing will prioritise flexibility to meet identified needs through updated funding flows and contracting arrangements. This will reflect the need to move decision-making closer to the frontline, and will require joint work across systems, places, and providers to ensure that future arrangements are both sustainable and effective in delivery.

To meet the collective needs of the community and ensure INTs are responsive, governance must give those working within neighbourhoods greater control over available resources, enabled by joint management, a “high-trust, light-touch” approach, and shared resourcing across INT partners. This represents a significant shift in the nature of relationships between INT organisations which have historically been bound by place / service-level contracts and institutionally-siloed performance management regimes. Investment in organisational development will be required to manage and deliver this shift, alongside:

• Flexible funding allocation and resourcing which allow neighbourhoods to allocate resources towards changing high priorities and places to re-allocate funding to identified population health priorities.
• Flexible use of existing flows such as ICS’ use of the existing NHS Payment Scheme to encourage innovation within INTs.
• Collective investment to reduce competitiveness, encourage networks of supportive partners, and mitigate against ‘tactical’ commissioning and resourcing. This might begin with joint investing in priority areas during INT establishment.
• Wider use of pooled resources including transformation and organisational development capabilities, and staff training and development capacity.
• Flexible contracting which moves away from activity or caseload-based models towards outcomes-based models and incentives which allow for professionals to respond to the patient as a whole and collaborate with the wider system.
• A flexible workforce model, (as described in the Workforce module of this operating model), which can draw in specialist input as required.
• A refresh of existing alliances and borough partnership roles including the role of ICB place teams.

To facilitate this we will implement an updated strategic commissioning model which includes the scope of services within the INT core offer, investment principles, and use of aligned incentives that all ICBs can move towards.

New funding cycles will be developed to enable funding of preventative approaches at scale.

Future funding will take account of the totality of INT budgets and not simply incremental year on year changes. Recognising that whilst many aspects of current funding regimes are outside of the control of local systems, systems should do more with the considerable budget certainty they do have. Regional, system, and place-based funding allocation will strive to:

• Be multi-year and recurrent to enable long term planning and the embedding of integrated working.
• Have streamlined and simplified flows which are more easily navigable.
• Recognise the long-term nature of preventative impact in performance monitoring.
• Recognise community-level impact of the way in which we harness our shared resources in addressing population health needs.
• Lock-in funding toward community-based interventions providing the certainty to allow organisations and partners to invest in new approaches to managing capacity and demand.
• Specifically, improve the stability of funding for VCSE organisations in acknowledging their core role in the delivery of neighbourhood health and care services.
• Ensure balance between primary, secondary, and tertiary prevention in coming both to the aid of communities and services today, and creating a sustainable and fair future.
• Require proportionate monitoring and administration, reducing bureaucracy wherever possible to improve access.
• In the short-term, look to “unlock” momentum toward integration through small, well targeted investments which can successfully catalyse neighbourhood working for the long-term.

We will establish funding for supporting prevention at scale. Whilst there will be a need for an immediate neighbourhood focus on short-to-medium term interventions which help to stabilise current health and care performance and finances, including targeted secondary prevention, taken in isolation these will only partly address the causes of growing health inequalities in London. Addressing wider determinants of health and wellbeing will require a shift over time of funding moving beyond traditional activity reduction targets. A longer-term view on return on investment across London will create the time and space for INTs to embed and mobilise, with “space to fail” and to iterate effective models.

Within this, we will make our public sector estate a catalyst for integrated neighbourhood working and improved outcomes. Estates must be understood as a catalyst for delivering seamless care closer to home, facilitating integrated working; and addressing inequalities of access. They must be a central consideration in the design of INTs and their geographies. Integrated asset mapping and planning will consider where there are productive opportunities for co-location; where there may be disparities in access for different cohorts and geographies; and where local assets can be better leveraged to address those disparities.

Co-location is a powerful means of accelerating neighbourhood working by providing environments for face-to-face collaboration between professionals, and improving access and engagement for residents with an identifiable physical community presence. When determining co-location requirements, places and neighbourhoods will exercise flexibility, linked to measurable outcomes and with consideration of the most efficient alternatives to enable access and promote collaboration. This will involve:

• Maximise the use of existing high-quality buildings.
• Take an expansive view of where physical spaces across our systems can be utilised – creative examples include housing estates, schools and religious centres.
• Deliver equity of access for both staff and residents: community assets should be in spaces accessible and suited to local people and staff, and provide space suitable for collaboration.
• Places/neighbourhoods will set out carbon reduction plans toward carbon neutrality, for instance through renewable energy initiatives or energy efficiency improvement in the use of estates.

Financial forecasting tools will be used to assess the impact of funding and resourcing over the long-term, and ensure models of care are effective and sustainable.

We will develop contracts and commissioning which operate on a population and INT basis rather than a place-based or service-level basis.

Contracting arrangements will create the conditions for integrated, outcomes-focused working which will straddle traditional organisational or service boundaries.

We will enable a devolved “high-trust, light touch” model of decision-making through:

• Assurance provided at place and neighbourhood level maintaining a detailed, accurate and reliable system-level picture of activity, resource allocation, spend, and performance.
• Willingness from organisations at all spatial levels to accept a degree of risk and redress perceived power-imbalances between organisations by embracing INT members as equal partners.
• Effective communication and simple delegation and escalation processes between ICB, place, and neighbourhood.
• Local cross-organisational alignment and agreement of INT goals and outcomes, aligned to place and ICB priorities, and set out in co-designed delivery plans.
• Clear shared local accountability for outcomes across INT partners, where each partner has oversight over performance and delivery.
• Contractual levers and incentives which encourage neighbourhood allocation of resources.

We will develop transparent funding processes, facilitated at place and ICB level, with effective integrated working and team working through regular shared planning and decision-making; shaped through organisational development and change management; and clear risk management, assurance and dispute resolution processes.