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Integrated Care Systems: the right time for change

Emily Mayne Emily Mayne

The NHS ‘Integration’ White Paper invites organisations to think about wholesale redesign of services. Emily Mayne explains why Integrated Care Systems (ICS) can increase scope for public and voluntary sectors to collaborate on local solutions.

Covid-19 changed the way services were delivered in a short space of time, proving that the NHS can be agile and think outside the box when supported by regulators. More importantly, Covid-19 changed the public’s perception of the NHS. We clapped for keyworkers and took responsibility for our actions to ‘stay safe’.

However, two years’ on from the first lockdown, the public has reverted to normal behaviours. There is an expectation that waiting times will return to pre-pandemic levels and that the NHS will be able to ‘fix’ the impact of years of poor lifestyle choices across the whole nation. The growing and aging population, developments in medical treatment which come at a cost, and an almost unrealistic expectation from the public around what the role of the NHS is, means something has to change.

Making space for strategic thinking

Implementing significant change is a big ask at any time, but the NHS is currently facing a unique combination of challenges. The backlog caused by the pandemic is amplified by the increased complexity of deferred treatment, coupled with a stretched workforce as bodies face issues with recruitment and retention. Senior leaders need to maximise the benefits set out within the Integration White Paper, to think differently, and collaborate, using the resources available to provide better outcomes for patients.

The day job alone for NHS staff is a huge ask, so finding time for the strategic thinking and leadership required to maximise the benefits from integration feels like the icing on the cake. But, with resources limited, and not necessarily in the right places to address current and future patient demand, the pace of change seen over the past two years must continue, and system thinking has to develop quickly.  

Our NHS senior leaders have lived with ‘management of change’ throughout their careers, with continual transformation of services to keep pace with demand. This is because when the NHS is allowed to stop and stand still, we're by default accepting that this is as good as it gets. And that's not good enough. We recognise that managers are at capacity, but they have proved they can change at a rate no-one thought possible three years ago. There's now an opportunity to reallocate resources, develop system thinking, and meet the challenges of today and tomorrow. But will the vision set out in the Integration White Paper be delivered and provide better care and better outcomes for more people?

On the eve of the creation of Integrated Care Systems (ICS), Boards (ICB) and Partnerships (ICP), the NHS is seeing a far greater focus on collaboration than ever before.

What's so good about ICSs?

ICSs are the latest thinking on how to address the current failings in the delivery of care. Providing control at a local level across a wider public sector and third sector footprint is a positive move, bringing NHS and local authority resources together to tackle key challenges around health and social care which are crippling both councils and provider trusts. This presents a fantastic opportunity to do things better, with a real focus on the patient and longer-term health outcomes.

The span of control over resources will be wider, increasing the need for joined up thinking around what health and social care for an individual should look like. But this continual bounce between local independence and central control is a dilemma which has challenged the NHS for the past three decades. Since the creation of the 'internal market' in the early 1990s, where local clinicians were given control over their own budgets, the NHS has struggled with how to make this work effectively. Bringing other bodies into the conversation will therefore be a significant challenge.

An Integrated Care Board (ICB) will sit within each ICS and support decision making on NHS resources, both financially and operationally. To support a local approach, GP practices will form Primary Care Networks (PCNs) covering between 30,000 to 50,000 patients, holding modest budgets to ensure that services can be shaped in their local area. However, current primary care arrangements are facing criticisms, channelling patients away from GPs and minor injury units to emergency departments. A combination of capacity constraints, services not being available at required times, and the public’s lack of understanding on how to access appropriate care is resulting in pressure on the acute sector.

So, the key test will be for ICBs to take the bull by the horns and start delivering the vision the Integration White Paper offers. Embracing transformation to provide the right care, to the right people, at the right time will be a challenge. Enabling greater provision of proactive, personalised, co-ordinated and more integrated health and social care, closer to home and within the same resource allocation is the prize. But the public will have to understand these changes, have confidence in accessing services, and learn new behaviours. This education will take time and there's a risk it could destabilise the change programme if not communicated effectively. It will also require complete and accurate data to inform system decisions for new patient pathways.

A way forward through the White Paper

The NHS White Paper offers the opportunity for organisations to think about the redesign of services using digital technologies to support integration of health over a wider footprint, and link it to social care for the benefit of service users.

Better data sharing and a focus on enabling workforce integration could help to improve care for individuals. ICSs will be required to bring all organisations to the same level of digital maturity, using compatible systems to provide care teams working across an individual’s pathway with accurate and timely data. The ambition is to achieve this on a national scale, but the inter-operability of digital systems may hamper the pace at which this can happen.

There's genuine excitement within the NHS about the White Paper, and a recognition that this is a once-in-a-lifetime opportunity to really transform the way services are delivered for the better. Leaders have proved they can enact change at pace when given the authority to make decisions without being hampered by regulators and without the pressure of meeting annual targets.

To support this transformation, several key actions are required:

  • Systems must understand what local long-term outcomes are needed and how these can be achieved through fundamental service redesign
  • System-wide thinking needs to focus on how patients will move seamlessly between organisations to access health and social care and facilitate this change
  • Senior leaders have to create the headspace for strategic thinking and work with system colleagues to implement difficult decisions at pace
  • Clinicians require empowerment to lead clinical decisions, rethinking current practices, and health outcomes without being curtailed by short-term metrics
  • The public must understand how changes in service delivery will impact their experience and take greater responsibility for accessing care appropriately

The vision set out is ambitious and requires wholesale commitment, but is a fantastic opportunity to improve outcomes, tackle health inequalities, enhance productivity, and support the well-being of local populations in a meaningful way.

For more insight and guidance, get in touch with Emily Mayne.

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