[Andrew Bennett]:

Integrated care is just a way of saying joined up care.

I think what we are trying to do as a group of organisations is make sure that people when they are going through the healthcare system, feel like their care is joined up.

We've had a system that was invented about 30 years ago, of commissioners and providers and we talked about them being split, separated from one another.

And I think one of the effects of that has been we have ended up doing things to people, to people in the population, rather than with them.

So I think my my ambition, my vision for integrated care is that we're actually doing what people wanted us to do.

We want to work better together to join up the care that they get.

There are lots of good examples of how we are already joining care up.

We are doing a lot in our local neighbourhoods where perhaps GPs are working with the local social care department, they might be working with the police or the Ambulance Trust.

And talking to people in those communities about how we can join up the care around them.

That's prompting some really amazing results in parts of Lancashire and South Cumbria.

Inside a hospital you might ask different professionals to work together to improve a pathway for someone when they need hospital treatment.

But the other element to this is thinking about the future, planning for the future.

We know that our population is getting older, for example, so people's needs in old age are perhaps different from how they were 20 or 30 years ago and we can do a lot more for people of course.

We also have some really clear pockets of deprivation in Lancashire and South Cumbria and we need to be taking some action over a number of years to really help people to address those and be healthier in the longer run.

The take-away message from me is that we should carry on being really ambitious.

I think people come to work wanting to do their best, they often talk about making a difference.

And actually in in most people's day-to-day lives they want to do that, they want to look after their patients or they want to support citizens in the community.

So this is about building a sense of community to improve all of our population's health.

[Dr Amanda Doyle]:

We have got this traditional model, a way in which we have always worked.

Which has very much relied upon diagnosing and treating and discharging patients and very hospital based.

But actually what we are seeing now is an increasing number of elderly people with long term conditions and the aim for these patients is often to keep them as well as possible and independent in their own homes for as long as possible.

If we continue to work in the way we've traditionally worked, we are never going to do that.

That will be an impossible ask.

The reason for that is that demand is continually outstripping our ability to deliver care.

We also have to recognise that unless we take a different approach to preventing ill-health and to enabling people to manage their own long term conditions we are never going to keep up with demand.

And one of the solutions to that problem is to integrate care, so that instead of all of our organisations working in isolation, we bring them together, we integrate things so that we deliver services more clinically effectively but also cost effectively.

And so this is about making people healthier, influencing the lifestyle factors that lead to ill-health.

Whether that's smoking, it's obesity, it's alcohol, it's substance misuse.

We have a high incidence of mental ill-health.

We need to develop resilient communities who understand their health, who know what to do to keep themselves healthy.

And who also know how to manage long term conditions, things like diabetes and asthma and chronic pulmonary disease once they've got them.

So we're developing networks of Primary Care practices and community services within neighbourhoods, working with community groups, the voluntary sector and the community in those places to really empower people to help look after themselves, help keep themselves well and to give people other options rather than just traditional health services when things go wrong.

[Mr Andy Curran]:

Within Lancashire and South Cumbria it's really important we have an integrated health and care and social care partnership.

We have some incredible challenges, when you look at us compared to other parts of England.

We need to make sure that every person who is born has the best possible chance of living a healthy, productive life, where they are happy with their wellbeing, where they have achieved what they want to be.

If we just focus on people who have disease and ill-health it's too late.

We need to help people prevent themselves from becoming unhealthy and becoming unwell.

It's enabling people to make their own choices, but feeling like it's worthwhile doing that.

Co-designing the services that we deliver is really important.

Knowing what is important to our population, what they value.

The people who are getting really good satisfaction from their lives and happiness with their lives are able to create their own wellbeing.

We need to make sure as society that we are enabling people to do that.

We've heard a lot of talk before, we've heard a lot of promises but now this is about relationships, this is about sitting down in a room with people and all of us being in this together.

It's not about competition between the organisations, it's about looking each other in the eye and saying: 'We are going to do our best'.

Which might mean that my organisation isn't bigger it doesn't have more money coming in, but actually, this is all about the patient and our public and making sure we do the right thing for them.

It's a really exciting time.

[Gary Raphael]:

We've all got a stake in the performance of all of our organisations that work round here.

If you are really successful as one organisation but your neighbour down the road perhaps is struggling there's a mechanism in place now which means that if we don't help them out, if we don't ensure that they are able to meet their objectives just as well as we are in this particular organisation, then we are all going to fail.

And I think what that will do, it will encourage a lot more partnership working between the organisations.

Not just in finance, but also in the way that we might share staff, the way we might organise the way that pathways work, how we share our expertise.

If we can get more efficient in those areas, we can release those resources to perhaps pick up the things we're not doing so well at the moment and maybe even do some things like get our waiting lists down, get our waiting times down.

We can start to use the money in that different way.

So the financial agenda for the NHS, and for the rest of our partners across Lancashire and South Cumbria is not just about savings, it's about how we utilise the money better than we are now.

And there are opportunities to do that.

I think the take-away message for the public and for our staff is that what we need to do in the health services and in public services is get the best deal for them in how we spend their money.

And if we do that as a system we've got more chance of being able to succeed than if we just leave it to individual organisations and that's what we are focused on.

[Talib Yaseen]:

We have an integrated care system in Lancashire and South Cumbria so that we can try to provide more coordinated and connected services for the patients that we serve.

Part of what we need to do is take all of the resources and say could we do things differently, could we provide more reliable, safer services but within the financial resources that we have.

So that's part of what we are trying to do.

Most of that isn't about the money, or the buildings, it's about a mindset.

What could we do differently, how do we learn from other people across England or elsewhere in the world that have got really well organised services but done in a different way to the way that we do that.

We need to balance up how do we do stuff locally, that meets local need and some of that is very place based.

It might be around six streets or a particular neighbourhood.

Some of it is saying no, the best way to do this is to put it in a specialist centre where you do lots of it, people are expert, and we can get you in and out quickly.

That's the real challenge that we have but to do that in an open and honest way.

Not everyone wants to be involved in that conversation but our job is to take that conversation to them and to at least try to inform them about what the possibilities are.

And there will be different world views and we have to accept there are different world views and not everyone will be supportive.

But we have to look at how do we make the best use of our staff and resources and how we organise care for the whole population, so ideally make the best use across the system but also make sure that that local service meets the needs of people

24 hours a day 7 days a week.

[Karen Partington]:

We are all facing the same problems around workforce.

There are too few people for too many jobs that we all have vacant at the moment.

That is the position across the country not just for Lancashire and South Cumbria.

So by working together it means that we can bring all of the ideas about the different roles that we might be able to use as substitute roles.

For example, we know that some of our medical vacancies are really difficult to fill so if we start to look at what are the skills required for those roles, can we use other people to actually fill some of those gaps.

So I think by coming together it helps us understand the pressures across the system but also to pool our ideas, our innovative solutions together so that we can move forward.

Working together is important because if we start to operate as silo organisations we will see the same workforce moving from one area to the next.

Actually what we want to do is to make this a really attractive place to work.

So we are bringing in people from outside of the region to work alongside our teams.