Following publication of the National Audit Office’s report on Integrated Care Systems and NHS England’s new operating framework, Managing Director Will Warburton puts forward the view from the Shelford Group that in a time of immense and sustained pressure on health and care services, clarity on the respective roles and responsibilities of Integrated Care Systems, Provider Collaboratives and Providers will be critical in enabling improvements in health, patient care and value for money.
Working together to keep people well and patients safe
It is hard to overstate the challenges as the NHS and Social Care prepare for the winter ahead. Health and care providers and their staff, including Shelford members, are doing all they can to provide the safest and most timely care to patients possible, during what looks certain to be a sustained period of intense operational pressure.
Shelford members are working with partners across Integrated Care Systems – both our host systems and those of the wider populations we serve – to expand bed and staffing capacity, to improve handovers to emergency care, to keep people well in the community and avoid admission to hospital where possible, and to get people out of hospital and back home or into community settings safely.
All these goals require co-operation and partnership across health and care systems, with our local populations and communities, and with colleagues in primary care, community and rehabilitation services, mental health, ambulance services, acute hospitals, the voluntary sector, and social care.
The respective roles of systems, providers and provider collaboratives
Shelford members regard the vehicles for collaboration that Integrated Care Systems offer as important in meeting the pressures ahead, and well placed to make a difference on improving access to the right care in the right setting, for example through work on discharge arrangements, falls prevention and management, care home support and working with high-intensity users.
Our view is that the value that Integrated Care Systems will add will come primarily from their role in convening and enabling collaboration between partners within and beyond the NHS, rather than as an additional management layer.
Integrated Care Systems provide an opportunity to approach problem-solving in new ways, particularly on areas such as enhancing the resilience of vulnerable services, achieving better co-ordination of care, boosting prevention, and reducing inequalities – although, as the NAO report points out, shorter-term financial and elective recovery goals risk crowding out these important agendas. Our members are also playing leading roles in developing Provider Collaboratives and place-based partnerships, which we see as valuable vehicles for making progress on service transformation and reducing unwarranted variation.
Our members are therefore fully supportive of the development of Integrated Care Systems. Several executives from our member organisations have taken on leadership roles in systems when they were in their shadow form, and all are leading and partnering today on work that will make a difference to our local populations this winter and beyond.
Examples include place-based initiatives such as Collaborative Newcastle, work in Sheffield with primary care and community partners on streamlining access to urgent care, and clinical teams across primary, secondary and community care pushing the boundaries of what can be managed through ambulatory care in Oxford. Our members are using their capabilities and assets to improve health in their communities, for example through this work on population health and equity at Imperial. In Manchester, the Provider Federation Board is taking on system leadership on behalf of Greater Manchester Integrated Care on urgent and emergency care, elective recovery, cancer and mental health.
Focusing resources and decision-making at the right level for patients and populations
Our members also recognise that the greater scale of Integrated Care Systems may allow for approaches that were not possible under previous structures. For example, we are supportive of the delegation of commissioning of specialised services to Integrated Care Systems for more common services, while working with partners at system and national level on mitigating the risks of transition and developing workable solutions for those services that cross multiple Integrated Care System boundaries – recognising that a single Integrated Care System will rarely be the right population footprint for planning, commissioning and delivering these services.
We are committed to working with partners to ensure we improve equity of access to specialised services and accelerate the transfer of knowledge from specialist centres to general and community settings – emerging partnerships such as the East of England specialised services provider collaborative, which spans six Integrated Care Systems and includes seven acute and specialist trusts across the region, provide one model.
Across all these reforms, we are supportive of the principle of concentrating resources and decision-making as close to patients and communities as appropriate – localising where possible, but still centralising where necessary. We welcome NHS England’s clarity on the operating framework for the NHS, including the intention to develop clear agreements on oversight arrangements for providers that avoid duplication of reporting requirements. We also welcome the redeployment of staff from national to system and local level, and the intention to keep time spent on governance proportionate, so that executive leadership and management energy is released to go into problem solving and enabling improvement at the frontline.
We agree too with the policy approach that that each geography will need to establish arrangements that take account of local differences. At the same time, the scale of our members’ activity means operating across multiple systems, collaboratives and regions. There is therefore a risk that without agreed priorities and careful co-ordination across collaborative vehicles, there is significant potential for misalignment of activity.
The challenges ahead are immense, but as the response to the pandemic showed, the commitment and capability of staff across the NHS and Social Care to rise to those challenges should also not be underestimated. Shelford members are committed to bringing the collective knowledge, experience, and capabilities within our organisations to the system response in the months and years ahead.