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Stewardship

Stewardship is an approach to health and care services that we are developing across the Mid and South Essex Integrated Care System. It is about bringing together teams of health and care staff and managers within a care area, to get the best value from our shared health and care resources.

Transcript: Find out more about Mid and South Essex NHS Stewardship

“Across Mid and South Essex, we’re on an exciting journey to achieve two simple things: better support for local people to stay healthy and independent for as long as possible, and making sure when our people do need services, they are high quality and focused on delivering what matters the most—the best possible outcomes for each individual.

Now, what’s new is that our partnership of health and care services are now coming together in an Integrated Care System to steward our resources. At the moment, the way health and care services work as separate organisations can limit the opportunities to look at the overall picture. We want to focus on listening to local people and staff, on working smarter, following best practice, so that we get the most benefit from every partnership pound. Fragmented resources can often result in fragmented care, that can lead to a poor patient experience.

Collaborative, joined-up working has been a long-standing aim of many organisations, and we have a real opportunity to act and do things differently, to tackle long-standing barriers linked to data and funding flows.

Our greatest asset is you; it’s us; it’s our people. We recognise the value in people who are from different backgrounds, communities, and experiences. We recognise the need to have these voices shaping our future and want to empower Mid and South Essex to take collective responsibility to a new level, to improve our health and care in an approach we call stewardship.

Frontline clinicians and managers are already coming together to explore opportunities for improved management, care, and support in six care areas, sharing a collective responsibility for stewarding resources within their care area, directed by local population health data. Through working together, our staff can bring tangible benefits for health and care professionals and the people they care for.

Our health and care partnership will be about stewardship. It’ll be about making the most from our shared time, energy, ideas, knowledge, and investment to bring deeper and wider impact—better outcomes for people living across Mid and South Essex, with individuals feeling in more control of their lives and their needs.

What we want to achieve

Teams must deliver on the Triple Aim.

The Triple Aim is set out in the Department of Health and Social Care’s White Paper in Feb 2021 – Integration and Innovation.

This sets three challenges for every Integrated Care System like ours. 

  1. Better health and wellbeing for everyone
  2. Better quality of health services for all individuals
  3. Sustainable use of health and care resources

Transcript: Stewardship expo 2023 – how stewardship is working in mid and south Essex


Well, today was a really important day where we brought together people from across our health and care system to learn about what’s been happening with stewardship to date and to plan what’s going to happen in the future.

And we’ve had a great morning.

As you can hear, the room is full of a range of professionals and people from the front line, patients, clinical leaders, and other stakeholders who’ve come together around a common goal of delivering improved services and integrated care to our population.

It’s been a fabulous day.

Today. For the first time in ages, we’ve brought together all of our stewards together around a single challenge. Where do we go next with our integrated care system?

And it’s been so exciting having all of them together with execs and non-execs and people from different organisations to come together to celebrate stewardship.

It’s a really good opportunity to bring together all of the existing stewardship groups and introducing us to new stewardship groups.

And it’s a really, really good opportunity to see what’s been going on for the last couple of years, but also it’s great for the newer stewardship groups to see where the older stewardship groups are in their journey and the kinds of things that they’ve done as well.

We’ve never done this event on this scale before, and today’s absolutely fantastic to see so many various organisations and it’s really great because we’ve got new people that have come in that shine a slightly different lens on where we’ve been previously.

And you can feel that buzz and the excitement and the energy in the room so it’s a great opportunity and to do it face to face.

I think from an NHSE perspective, we’re always interested in how systems are already working and how systems can work.

I think what I’ve seen today is, a fantastic example of some of those really core principles of system working as opposed to kind of more fractured approach that is probably more what we’re used to doing historically. 

It shows a real change and the energy in the room is fantastic in terms of the way people have really embraced a different way of doing things.

I’ve been blown away with the amounts of fantastic partnership working and the real focus on improving care at patients.

I would say the biggest takeaway for me is making sure that our organisation, each of our hospital sites and our teams, have the time and space to help to contribute to the work across the county in improving care for patients.

Healthwatch Southend is the local voice of people who use health and care services, and we’re really keen to work with stewards in the future to really amplify the patient voice.

We’ve heard some good examples this morning, but I think there’s a lot more that we could do to bring patients in and to bring their lived experience to bear and influence the changes that we want to make together.

It’s really important to think about how we bring their experience and the outcomes they have to sit alongside some of the financial discussions that that need to take place in the stewardship group so that we’re actually improving outcomes and making good use of resources at the same time.

And rather than reinventing the wheel, we need to learn and share from what’s working and actually get that out into local communities. And this is a really good opportunity to do that. 

I think people have recognised that stewardship is not a little niche event, that stewardship is something that crosses our entire system and needs to have collaboration across the system and I think people now can see the real potential of stewardship, uh, for Mid and South Essex.

Stewardship has its roots in values and approaches that the NHS has had since its inception.

From my standpoint, it’s really good to see that this is something that’s going to continue.

It’s coming towards the end of my time in this system, but I leave it in good hands and I can be absolutely confident that the work that’s begun is going to continue.

From the beginning to end we’ve had so much energy and enthusiasm, the fact that even though our world is changing, we’ve got new leaders coming into our system, dedication to stewardship, and the values that it entails remain steadfast.

And I think hopefully people will see that from the reactions and presentations from our leaders today.

It is great to be here and it’s great to be here primarily because what I’ve learned in the last hour, and indeed while I’ve been listening to you, I have been busily emailing our ICS network and our external affairs team saying, we must showcase the fantastic work that you are doing because it is exemplary patient focused across system work.

It’s fantastic to watch. So, you know, even if the tech broke down now and you couldn’t get a word from me, I would’ve, gained a lot from listening in.

We’ve had the opportunity to celebrate some of its successes, but we’ve also had the opportunity to share ideas for what happens next.

And certainly, I know I’ve taken some ideas away about how we improve the way in which we’re managing resource across the system.

So it is been a really great morning.

I think the key message is to capitalise on this enthusiasm and this moment of hope, actually.
I think if we learn from each other and actually realise there is a way out of things that seem really hard, but it might be a slightly different way to what we’ve done things.

But actually to put our faith behind that and really join together in that effort, I think that’s the key message.

And I think it’s fantastic that here in Mid and South Essex we are taking this different approach because it is going to be the right approach.

And I think everybody, we’re all stewards, all of us. I think in a system like ours where you’ve got people working across, you know, several different sectors, 15 different organisations, days like this is a really useful chance to come together so that everybody’s got visibility of the huge amount of stuff that we’re all doing, in our different care areas.

I think given the energy of today, all the stuff that we’ve heard about in the sessions, I’m really looking forward to coming back in one year’s time to hear about all the work that 10 groups now will have done over the, the next 12 months.

Where are we now

Phases one and two.

The first phase of the stewardship programme sees six groups, called ‘Stewardship teams’ define their care areas in terms of the resident population who may need health and care resources, the level of shared resources within their care area, current service activity, burden of disease and outcomes.

The first six care areas include: 

  • Ageing well
  • Cancer care
  • Cardiac care
  • Respiratory care
  • Stroke care
  • Urgent and emergency care

The second phase

We are now looking to develop six new stewardship groups, each comprising of 10 stewards:

  • Mental Health and Learning Disabilities
  • Children and Young People
  • Dermatology
  • Ophthalmology
  • Musculoskeletal
  • Diabetes 

All new stewards are provided with development opportunities, including training in value-based healthcare.

Through the Stewardship programme, they will be able to access broader, better shared data and intelligence, engage widely with staff and residents in order to re-prioritise how resources are used. 

They will have the responsibility to re-shape how health and care services deliver value for our residents. 

What is different about Stewardship? 

Shared thinking, shared responsibility.

Stewardship is about forming teams that bring together perspectives from the whole cycle of care, i.e. from across all services supporting residents moving through our health and care system, from before they enter, too after they step out.     

Lived experience of local people is key, with a strong emphasis on involving our residents in defining what ‘value’ means. 

The experience, knowledge and leadership by health and care staff allows Stewardship teams to identify areas where using evidence-based practice and more joined-up working can improve quality and make better use of our resources. 

This approach has the backing and support of senior leaders within our system, including the Chief Executives of each organisation. 

Shared Resources: care area budgets

Stewardship teams focus on how we can best use the health and care resources available within each care area (i.e. pooled resources between all organisations) on outcomes that matter most to individual patients and to our whole population. 

Shared Data: Population health management

The approach uses different sources of data to understand the health and care needs of our whole population, identifying inequalities and vulnerable populations, and then developing solutions to improve health and wellbeing tailored to our population. 

Overall, Stewardship will:

  • Close the gaps between health and care services for our patients and residents.
  • Empower health and care staff from all organisations to be at the heart of service planning. 
  • Enable our Integrated Care System to deliver on the promise of Integrated Care. 

How can people get involved? 

Stewardship teams will need to engage and collaborate closely with all those in their care area, in order to:

  • truly understand the full cycle of care, experienced by residents and delivered by staff
  • develop and co-produce proposals for improvement
  • deliver change together 
  • evaluate impact 

If you are believe you would be a good steward and would like to find out more, please email: [email protected].