Research report
10 Nov 2011

This study of efforts in Trafford, Greater Manchester, to deliver integrated care provides valuable insights into the challenge of service reconfiguration at a time of financial constraint.


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Nuffield Trust Visiting Senior Fellow, Dr Sara Shaw, on the findings of the first phase of a study exploring the development of integrated care in Trafford.

Trafford, a borough of Greater Manchester with a population of 215,000, is well known for being the site of the first NHS hospital. However, partly in response to a financial situation that has made it impossible to sustain health services along previous lines, clinicians and managers in the borough have since 2008 been working to develop an integrated care system where a wider range of community-based and specialist services are provided.

The Nuffield Trust has been working with colleagues in Trafford to carry out an in-depth study tracking the development of the new integrated care system. This research report examines the Trafford experience, with an emphasis on the process of change required to achieve integration, describing the main phases of work, and the successes and challenges associated with each.

Trafford’s story underlines the point that there are no easy solutions or quick fixes – they have managed to withstand many hurdles by lining up the right people early on and building close relationships, founded on a clear, shared vision

Dr Sara Shaw, Visiting Senior Fellow, Nuffield Trust

Important lessons from Trafford’s experience of developing a more integrated system include:

  • Integration can take a number of forms – ranging from loose collaborations to a full merger.
  • Meaningful collaboration across professional groups is vital – in Trafford, six multidisciplinary clinical panels are responsible for redesigning services, which are supported by a locally-tailored international leadership programme.
  • Relationship-building is key – this means it is possible to make progress on redesign even while structural issues are still being worked through.
  • Good information systems are vital – these underpin effective commissioning decision-making and performance monitoring.
  • Meaningful change takes time – the Trafford experience suggests a minimum of a year, and probably more, particularly before the financial benefits are felt.

Towards integrated care in Trafford, by Dr Sara Shaw and Ros Levenson, will be of interest to health leaders, policy-makers, health and social care commissioners, policy-makers and researchers with an interest in integrated care, as well as health and social care organisations seeking to bring about radical change.

The Nuffield Trust’s work with Trafford is ongoing, and this research report contains the findings of the first phase of the project. The second phase of our research focuses on the impact of integrated care by examining shifts in service use, finances and patient experience that happen as a result of the new model of care. Visit the dedicated project page for further details.

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