Johanna Davies, WCVA Head of Health and Social Care, reflects on the importance of understanding problems before looking for solutions, and what that means for collaborative commissioning in Wales.
I attended the International Foundation for Integrated Care (IFIC) Summer School in Oxford to strengthen my understanding of integrated care, challenge my thinking and learn from systems across the world. I also wanted to test whether WCVA’s Health and Care Project is asking the right questions and focusing on the right problems.
I came away with pages of notes, new connections and plenty of ideas. However, my biggest learning was not about a particular model or intervention. It was that successful integrated care starts with understanding the problem, not designing the solution.
CHALLENGING ASSUMPTIONS
This challenged some of my assumptions and influenced me to think differently about our emerging collaborative commissioning work with the National Office for Care and Support.
Our project is not about redesigning services or solving every challenge facing the system, nor is it about delivering commissioned services directly. Instead, it’s about creating the conditions for people to work differently: giving people, providers and commissioners the time and resources to explore new ways of commissioning community‑based services that better meet local need.
Being explicit about what the project will not achieve is as important as defining what success looks like. Summer School reinforced that transformation initiatives need realistic boundaries.
Summer School was structured around the IFIC Nine Pillars of Integrated Care. All are important, but several particularly influenced my thinking about the direction of our work.
SHARED PURPOSE: UNDERSTANDING THE PROBLEM BEFORE DESIGNING THE SOLUTION
One of the first exercises focused on defining the problem rather than jumping straight to solutions. This resonated because our Health and Care Project started in the same place.
In 2022, we worked with stakeholders across Wales to explore what prevents volunteering and voluntary organisations from working effectively as part of the health and care system. The resulting Theory of Change identified challenges around recognition, governance, funding and involvement.
Summer School reinforced the importance of investing time in developing a shared understanding of need. It also made me realise that our planned collaborative commissioning work will require its own Theory of Change.
This work will explore ways to support good commissioning relationships that utilise collaborative approaches and will identify local commissioners of care and support alongside voluntary sector organisations.
If commissioners, providers, community organisations and people with lived experience define a problem differently, they are unlikely to agree on the right solution. Creating a shared purpose means exploring need from every perspective before moving into service design or procurement discussions.
The lesson is simple: spend longer understanding the problem and less time jumping to the answer.
PEOPLE AS PARTNERS: RELATIONSHIPS MATTER MORE THAN STRUCTURES
Summer School emphasised that integrated care is fundamentally about people and relationships. People build partnerships, not structures. Structures can support collaboration, but trust sustains it.
Our project was designed around a practical challenge: partners often lack time and resources to explore collaborative approaches, build trusting relationships and develop a shared understanding of local need.
Summer School strengthened my confidence that this focus is correct. Too often commissioning starts with specifications and procurement processes. Collaborative commissioning starts with understanding people, building trust and meaningful dialogue. The relationships are the work.
GOVERNANCE AND LEADERSHIP: MAKING ASSUMPTIONS VISIBLE
Integrated care initiatives often operate with unstated assumptions about commitment, resources, capacity and trust. We were encouraged to state these assumptions and test them.
I can see assumptions that need greater attention: that commissioners will adopt collaborative approaches, that improved relationships lead to better decisions, and that participants will have time to engage meaningfully. These need to be acknowledged and not taken for granted.
FINANCING: USING RESOURCES AS A LEVER FOR CHANGE
A recurring theme was that organisations talk about integration while continuing to fund fragmented ways of working. We must incentivise a change in behaviour.
This is particularly relevant for Wales as many voluntary organisations want to contribute strategically but lack the capacity to do so. We frequently ask organisations to participate in planning and partnership structures without funding the time required for it to work.
We wanted to address this by recognising and supporting participation. Summer School reinforced that financing is not simply about paying for services, it can change behaviours, relationships and culture.
LEARNING AND IMPROVEMENT: EMBRACING CURIOSITY
We were encouraged to approach innovation with curiosity and humility. Not everything works, and that’s okay.
If our collaborative commissioning pilots proceed, some aspects will work better than others. The important thing is that we learn from both success and failure. Our proposed approach includes evaluation and shared learning because creating a reusable model for Wales is as important as delivering the pilots themselves.
FINAL REFLECTIONS
I expected to learn more about integrated care, and I did. What I didn’t expect was how much the experience would strengthen my confidence in the direction of the Health and Care Project while also challenging me to think more critically about collaborative commissioning.
Integrated care happens when people invest time in understanding the problem, create a shared purpose, build trusting relationships and remain willing to learn together.
Our long‑term vision remains unchanged: volunteering and voluntary organisations being trusted and valued as equal partners in creating a healthier, more resilient and more equal Wales.
Summer School showed me what we need to achieve that vision – and reminded me that transformation starts not with the answer, but with asking the right question.