Change management driven by champions sustains and rolls out good practice commitment and flexibility to solve ongoing problems rewards success managed as a whole system presses on regardless not willing to devolve responsibility bogged down in organisational problems

Cross profession engagement sharing information and skills for the bigger picture open, honest, transparent communication shared records – creative use of IT centred on user need ‘we all own this’ lack of trust tribal, protectionist ‘WE own this’

Integrated health + social care teams Shared commitment to goals and objectives Interdependence of outcomes Clarity on role and accountability, including leadership Cultural congruity Focus on quality + innovation True co-operation Interprofessional trust and respect

Integrated budgets ‘integration in health and well-being services can be cost effective – however the evidence base is still relatively small’ (Turning Point, 2010) transparency accountability clarity

Leadership Long-term commitment, enthusiasm, involvement Shared vision and goals across partners, communicated to all Proactive promotion Building commitment, understanding, shared culture Achieving targets

Checklist for self evaluation Consultation with staff Common language Strong leadership and vision Staff development Clear identities High quality information systems Continuity and stability Respect differences Right people with right skills Risks identified and managed Clear decision-making and accountability Shared efficiencies Cost monitoring

Key issues Implications beyond older people Agreed national outcomes mixing personal and organisational Partnership with third and independent sector Leadership capacity Collaboration between health clinicians and social care professionals Achievement of integrated budgets