A case study on how the development and implementation of a cross integrated operating model in Greater Manchester supports better stakeholder engagement, increased capacity for delivery and positive health outcomes.
Themes: Organisational Structures, Health Inequalities, Partnership Working
Case study summary
Greater Manchester’s (GM) health, care and civic leaders share an understanding of the importance of health research and innovation in unlocking economic potential and addressing health inequalities. This shared understanding catalysed the formation of Health Innovation Manchester (HInM), bringing together the health and care system with industry and academia to accelerate health research and innovation into practice. In doing so, HInM has blended delivery of the Greater Manchester Academic Health Science Network (AHSN), National Institute for Health and Care Applied Research Collaboration (NIHR ARC), Academic Health Science Centre (AHSC) and GM digital transformation office into one integrated delivery organisation, allowing HInM to leverage a range of capabilities to deliver against national and local priorities.
What was the problem or opportunity?
GM has operated as a devolved health and care system over the last six years and following July 1st will become Greater Manchester Integrated Care Partnership.
Although GM comprises only one ICS, it is a complex system with a diverse population of approx. 3.1m people, living across 10 localities and 66 neighbourhoods. GM’s population experiences poor health outcomes, lower life expectancy, and high levels of unemployment and deprivation compared to other parts of the country.
The ICS includes a well-established Provider Federation Board (comprising 11 NHS trusts), a Primary Care Board (including 450 GP practices), an Alternative Provider Network (for the voluntary sector), and the GM Combined Authority (GMCA).
HInM delivers the full spectrum of innovation activities across health and care settings within the ICS through an established pipeline method. HInM’s work is wide-ranging and includes but is not limited to clinical trials, testing and implementing digital tools, digitally enabled pathway transformation and adoption and the spread of new medicines or proven industry products or services.
How did this support innovation adoption and spread?
HInM integrates the functions of the GM AHSN, NIHR ARC, AHSC, and GM digital transformation office, with the broader public service reform agenda. For each of these elements, HInM has worked on developing an integrated operating model to combine a range of core capabilities that deliver value to its partners, including:
- Digital strategy and solution design;
- Innovation development and deployment;
- Business insights, intelligence and benefits realization;
- Strategic industry partnerships; and
- Academic partnerships and applied health research.
In the past, HInM’s operating model was largely centered around a proficient programme management function with some supporting expertise. It has now evolved to provide a full range of innovation services to the system. Gaining clarity on these core services, aligned to system priorities, has been essential for pivoting the internal operating model and ensuring HInM is well placed to deliver a broad innovation portfolio within a complex health and care system.
Developing a robust innovation pipeline approach has also been essential to support the team to clearly define the problems that need to be solved, and to facilitate structured co-design and decision making with partners. Critically, each innovation project must have an external senior sponsor, as well as an agreed governance route through which key decisions can be taken.
There are five critical stages to HInM’s pipeline approach:
- Ideation – curating a range of potential innovations from multiple sources;
- Qualification – assessing proposals in terms of complexity and benefits, against defined GM priorities and citizen outcomes;
- Solutioning – developing programmes of work including identification of the citizen need and problem to be solved, clinical pathway mapping, redesign and technical development;
- Proof of value – testing the viability and value of the solution by deploying it into practice, identifying improvements and adjustments that need to be made; and
- Deployment at scale – deploying proven solutions at scale via agile delivery methods.
How were patients and the public involved?
Working in partnership with patients and the public is crucial to ensure that projects and innovations optimally address the health needs of GM’s diverse population, and that their voices and lived experience are built into all programmes of work.
HInM work in partnership with the public and patients most notably through two well-established mechanisms:
- Public and Community Involvement Engagement (PCIE) Panel – this core group brings together 15 local people from different social, economic and cultural backgrounds to draw their skills, knowledge and lived experience to HInM’s portfolio; and
- PCIE Forum – this forum is made up of patients, care professionals, voluntary sector partners and academics to share information, resources and ideas that support diverse public involvement and engagement and reflect the needs and priorities of individuals and communities in GM.
What were the results?
HInM has successfully delivered a suite of innovation projects agreed with GM partners, including:
- the ‘smart hearts’ project, to digitally transform the heart failure pathway using data from implantable devices which detect deterioration early;
- a programme to eliminate Hepatitis C which demonstrated positive outcomes for rapid point of care testing and curative treatment in prisons and via community outreach;
- The deployment of the rainbow specialist clinic across maternity units to support complex pregnancies which originated from the AHSC;and
- the Inclisiran real world study to test novel cholesterol lowering medicines in primary care, taking a population health management approach, enabled by digital cohort finding and outcome monitoring.
During the COVID-19 pandemic, HInM delivered a number of major programmes including COVID-19 oximetry @home virtual wards digital platform, accelerating the GM Care Record (which led to the creation of a GM Care Record for close to 100% of GM citizens), and digital care homes transformation to implement a pan-GM data sharing agreement, and a COVID-19 outbreak management tool across GM care homes at scale.
What were the learning points?
HInM has been on a continuous journey of evolution developing from an initial merger of different organisations through to becoming an integrated delivery organisation that is closely aligned with the strategies, plans and governance processes of the new GM Integrated Care Partnership.
There have been many lessons to reflect on over the course of that journey, key learnings include:
- Lead with delivery – the NHS is constantly evolving and changing at all levels, which can create challenges in implementing innovation projects. Clarity on the roles of each partner organisation, what sits within their ‘offer’, and when their involvement should end are key to ensuring sustainability of projects and eventual movement to business as usual. This also allows organisations such as the AHSNs to move onto the next big system priority with focus and at pace.
- Digital as an ethos – a clear focus on digital is key to unlocking transformational change and should be a priority (including technology, data, design, inclusion, capabilities, customer experience) in supporting the health and care system to evolve.
- Structured method and process – developing an innovation pipeline with established methods and processes enables staff and external partners to understand clearly how innovation programmes are designed and developed. This transparency around decision making, funding and use of resource builds trust and confidence within the system.
- Leadership and governance – having consistent visible leadership engaged in key system forums and groups, and communicating in a clear and consistent manner, has been essential to push the digital and innovation agenda up the priority list across the system. Establishing recognised system governance structures is also key to support shared accountability and decision making with partners. HInM have done this via the HInM Board and the GM Digital Transformation Board.
- Funding matters – As well as being funded by national partners, HInM also receives funding through the GM health and care partnership, and university partners. This enhances their ability to deliver innovation that meets local needs and the needs of their system partners who have a vested interested in helping to deliver benefits from innovation.
- People and culture – taking an integrated agile approach has been essential in ensuring HInM has the full range of skills and capabilities needed to deliver innovation at pace and scale. They have done this aligned to the priorities agreed with their system partners, and will continue to adapt and change as the GM system matures.
An independent academic evaluation looking at the work and impact of Health Innovation Manchester during its earlier stages can be found here.
Next steps and sustainability
In consultation with the HInM Board and partners across the Integrated Care Partnership, HInM has now agreed an integrated delivery portfolio across four key domains:
- Accelerate innovation at pace and scale – to ensure close alignment of innovation to GM’s major health challenges; and a stronger affiliation to commissioning and service transformation to ensure maximum benefits are delivered. This will involve curating an innovation pipeline aligned to GM priorities where innovations may be sourced locally, be mandated nationally or identified through international collaborations.
- Data science, pathway analysis and transformation – by forming collaborations with industry and academia to deliver data science projects to understand more about the needs of GM’s populations and communities. An example is the GM Care Record, which is evolving beyond a shared care record to become a next-generation digital platform supporting clinical pathway transformation to improve patient care. De-identified data from the GMCR is also being used to advance research on the impact of COVID-19 on GM citizens. HInM has also recently undertaken an extensive review of digital maturity across NHS trusts and primary care to inform a digital investment plan. HInM are currently working with the Provider Collaborative and the NHS Greater Manchester Integrated Care ICS organisation to lead the co-design and development of a system-wide model and mobilisation plan for virtual wards.
- Conduct traditional trials and real-world studies – continuing to build on GM’s excellence in recruitment to clinical trials, and work to harness all of GM’s data assets to deliver real world evidence studies. HInM is developing a life sciences and health tech industry strategy to optimise collaboration and value sharing with industry and partners. A prime example of this partnership approach is the novel Inclisiran study GM developed with industry and NHS England.
- Place-based transformation – recognising the importance of working at both a pan-GM level and with specific localities HInM will work on specific community-based digital technology projects to transform and regenerate local communities by addressing the many factors affecting health, wealth and wellbeing. This will be a partnership initiative as part of the broader GM Innovation programme to level up investment in research and development across the North.
Find out more
You can read more about HInM’s work at the following links:
- Health Innovation Manchester
- HInM business plan
- Academic evaluation of the formation of HInM
- HInM impact reports
Laura Rooney, Director of Corporate Strategy: email@example.com