Putting communities and citizens at the heart of what we do - The development of a continuum of integration within a locality in the Northwest of the UK to enhance health well-being and reduce inequalities.
Authors: Kelly Alison , Croasdale Sandra , Taylor Steve , Marshall Kirsty 
Published: January 2024

The Northwest of England has seen health inequality and poor health outcome be a persistent feature for the population. The area has gained economic advancement in recent decades, but these have not been equally shared, and many population groups suffer disproportionately (1). Rochdale is a multi-ethnic locality within Greater Manchester. Around a quarter of local people have at least one or more long-term conditions and a third of residents live within 10% of the most deprived neighbourhoods nationally(2).
The Health and Care Act (2022) aims to transform the commissioning and delivery of health and social care across the UK with a far stronger emphasis on integration and neighbourhood working as well as statutory responsibilities for the newly formed Integrated Care systems (3). For Rochdale, as part of Greater Manchester, this journey started pre-2016 with devolution and the movement of the 6-billion-pound budget to the Greater Manchester Devolved Authority. Devolution provided the opportunity to implement an ambitious plan to transform the health and well-being across communities through a focus on system-wide integration, harnessing community assets, and transforming the relationship between the system, and communities.
The Rochdale system took a radial approach to locality development, this started with thinking differently about the formation of the locality board that strategically plans for the location. The Rochdale approach that started with the concept of “in and out of scope” was not progressive or relevant when attempting to work with wider partners and the community. Equally, the changes in statutory responsibility potentially lead to greater complications in finances, accountability, and decision-making, these could all act as barriers to the integration of the service and the development of new models of care. Rochdale’s starting point was that “everything is in scope” and focused on a continuum for integration. Which enabled system partners to move to different levels of integration in a flexible way depending on the needs of the communities (from common interests to full integration with shared workforce and infrastructure). In this approach, the system is working towards ensuring clear accountability and responsibility for all parts of the continuum – for example, understanding quality, performance, and financial accountability at each level, while enabling a broad spectrum of engagement. The adoption of the continuum aims to be inclusive of a wider spectrum of partners magnifying the voice of held-back communities at a strategic planning level and enabling organisations to have clear expectations in driving forward sustainable change and integration. The learning for an international audience from the past 6 years of systems working and the development of the continuum approach is that this approach has the potential to cut through some of the barriers to integration, especially for organisations that may not form part of the central integration agenda enabling more innovative solutions to tackling inequalities.

Greater Manchester Combined Authority [GMCA] (2015) Taking Charge of Our Health and Social Care in Greater Manchester, Retrieved from:

http://greatermanchester- a.gov.uk/download/downloads/id/125/taking_charge_of_our_health_and_social_car e_in_greater_manchester.pdf

Rochdale Borough council (2020) Rochdale Borough Locality Plan. https://www.rochdale.gov.uk/downloads/download/462/rochdale-borough-locality-plan
Health and Care Act (2022)