By Stephanie Diller, Senior Manager, Public Sector Health Strategy
In 2019, our Integrated Care System (ICS) blog series set out key considerations and questions faced by NHS organisations as they responded to the Long Term Plan’s (LTP) expectations for every NHS organisation to form part of an ICS. However, since the start of the COVID-19 pandemic the priorities of health and care shifted towards an emergency response, slowing the transformational progress of many organisations in forming an ICS. This blog builds on our previous insights, identifies learnings from the pandemic and explores the implications for ICS planning of the Government’s February 2021 white paper, Integration and innovation: working together to improve health and social care. More specifically, it identifies the barriers that need to be overcome and the challenges ICS stakeholders will need to address when designing and implementing the integration changes that are needed to improve population health.
How has COVID-19 impacted ICS development?
During the pandemic, many NHS organisations’ paused their ICS transformation and implementation plans to deploy much needed resources and capacity to support the health system’s response to COVID-19. At the same time, wide-scale innovation and more flexibility has changed ways of working and care delivery, nationally, regionally, and locally, at an unprecedented scale and pace. Moreover, there has also been a previously unseen level of collaboration both within and between health and social care. Examples include:
- an almost immediate shift to deploy digital technology to diagnose, monitor and care for patients in their own homes and enable GP and outpatient appointments to be conducted virtually (see our Thoughts for the Centre)1
- increased investment in technologies enabling at-home testing, diagnostics and support2
- improved data reporting to support the urgent need to collect, analyse and report more effectively on COVID-19 related health data across systems and regions (the NHS Covid-19 Data Store enables real-time data access to inform decision making and reduce some of the red tape around data and information governance)3
- the NHS and local authorities working more closely together to make the move from hospital to care settings more seamless for individuals and the NHS and Directors of Public Health collaborating to develop more sophisticated approaches to population health management.4
What’s next for ICSs?
As ICS leaders and their partners reflect on the learnings from the pandemic and consider how to take these forward, the government’s February 2021 white paper, ‘sets out a Health and Care Bill to implement legislation to promote integrated care’.5 This bill builds on the work the system has been doing in response to the NHS LTP, and identifies solutions for overcoming acknowledged barriers to integration and bringing together NHS organisations, local government and wider partners at a system level to deliver more joined up approaches to improving health and care outcomes, based on establishing a statutory ICS in each ICS area. It sets out proposals to: support integrated working, eliminate unnecessary bureaucracy, and enhance public confidence and accountability; as well as providing additional proposals to support social care, public health and quality and safety.
The bill’s proposals will shape the following considerations for re-mobilising ICS implementation:
- ICSs as statutory bodies: aimed at removing barriers to join-up working across NHS organisations and local authorities (LAs) and giving ICSs statutory responsibility for the health of their population. ICSs will comprise an ICS NHS Body supporting system strategic planning and taking on some CCG functions and an ICS Health and Care Partnership to provide a springboard to support closer integration, underpinned by a duty to collaborate; including working with system partners, such as Healthwatch, to strengthen the public voice and improve population outcomes.
- Reducing bureaucracy that prevents integrated care: the proposals set out mechanisms to enable joined-up decision making and integrated care planning across social care, mental health and public health. These mechanisms include supporting an integrated workforce, enhanced data sharing to support system-wide decision making and changes to procurement rules to enable collective decision-making for healthcare planning.
- ICS accountability and responsibilities: The white paper also sets outs proposals for changes to accountability arrangements and roles across the NHS, giving NHS England an explicit power to set a financial allocation and objectives at a system level and a duty on the ICS NHS Body to meet the system financial objectives including achieving financial balance. Measures will also be taken to strengthen and clarify the role of Government and Parliament in encouraging integration and in supporting the independence and accountability of ICSs and their requirement to have regard to the ‘triple aim’ of better health and wellbeing for everyone, better quality of health services for all individuals, and sustainable use of NHS resources.6
Our reflections on how ICSs make sense of these proposals and move forward?
ICSs will differ in the approach they take and are unlikely to get everything right the first time. Rather, the mechanisms required and the journey towards integrated care to improve population health will be an iterative process that will be continuously improved to address the evolving needs of the local population while incorporating new technologies and interventions.
To support this journey, our opening gambit is to share our initial thoughts on barriers and challenges ICS stakeholders will likely experience and some principles for re-mobilising ICS implementation, based on our experiences working with health and care systems over the past year.
Over the past 12 months the increased collaboration across health and social care shows what can be done by working together flexibly, setting aside bureaucratic rules, and adopting new technologies focused on the needs of the patient. Building on the above insights, if the complex system is to integrate cohesively, there will be a need for a robust, flexible infrastructure within each ICS. Initially, partner organisations will need to start with an agreed set of principles on collaborative working, align their financial systems and develop a robust analytics platform to inform PHM planning.
Over the next few months we will conduct a deeper dive into the critical priorities identified by ICS stakeholders to understand the solutions that are being deployed to enable them to work through their priorities. We will share these insights over the coming months.
Acknowledgement: Thanks to my colleagues Catherine Skilton and James Banham for sharing insights that helped to shape this discussion.
1 The future unmasked
2 The latest in COVID-19 testing: developing new technologies - POST
3 ‘New Data Strategy to capitalise on ‘good practice’ during Covid-19’, Andrea Downey, Digital Health Net, November 25, 2020.
4 ‘Working together to improve health and social care for all’ , Department of Health and Social Care, February 11, 2021.