From April-November 2023, Public Policy Projects (PPP) held the ICS Delivery Forum across five locations – Manchester, Leeds, Birmingham, Bristol and London. Over the five events, more than 750 attendees from across the health and care spectrum joined to discuss the key local challenges in each area, share best practice, and highlight innovative examples of collaboration and partnership working, all with the aim of supporting the delivery of integrated care.
Below is a brief summary of key insights discussed over the course of the five events. To find more detailed summaries of the 2023 ICS Delivery Forum series, please visit PPP’s online report library.
ICSs are showing signs of maturity compared to this time last year and work to cultivate the space for effective partnership working is showing progress. Issues around contracting, governance, information governance and data-sharing in provider collaboratives are commonplace. ICSs, NHS England and the Department of Health and Social Care all have roles to play in addressing these barriers to collaboration, including the provision of financial support to enable effective governance at smaller organisations, such as social care providers and VCSE organisations.
- South Yorkshire ICS has created a hub for provider collaboratives that aims to minimise risk for providers by pooling certain functions, including commissioning and administration, and is looking into financing. It also has a role advising members on information governance and data sharing.
Effective collaboration between ICSs and industry are helping to drive improvements across diagnostics, case-finding and patient care. Organisations like the Health Innovation Network are acting as a crucial bridge between ICSs and industry, helping to share best practice and provide clarity over what systems need from industry, and specific priority areas that new innovation should focus on.
- A Collaborative Working Agreement between Roche, the Innovation Agency and the Health Innovation Network North East North Cumbria aims to improve influenza and Covid-19 diagnostic capacity in primary care settings to avoid unnecessary referrals into secondary care. Across its pilot sites, the partnership has demonstrated that preventing the deterioration of patients in primary care helps reduce pressure on secondary care services, as well as reducing the number of unnecessary antibiotics prescriptions due to greater diagnostic certainty.
- A joint-working agreement between the Northern Health Science Alliance, Amgen, Interface Clinical Services and the University of Sunderland has given rise to the Northern Alliance Bone Health Programme. The programme aims to “shape a population health approach to primary and secondary prevention of fragility fractures within osteoporosis” through systematic case-finding. Data analysis of more than 27,000 patients helped identify more than 12,500 patients with previously undiagnosed osteoporosis and develop effective treatment plans. If scaled across the north’s 16 million patients, it is estimated the programme could deliver savings of £43.6 million.
More complex collaborative agreements are being formed and these are beginning to have tangible impacts on patient care
- Collaboration between Warrington and Halton Teaching Hospitals NHS Foundation Trust and Runcorn Shopping Centre has led to the creation of the Halton Health Hub – offering dietetic, orthoptic and audiology clinical services to local residents at an easily accessible location.
Diversity of perspectives and professions at all levels of senior leadership level is supportive of the delivery of integrated care, enabling the development of holistic strategies that incorporate prevention, health inequalities and rehabilitation. ICSs are addressing this is a range of ways, including the rotation of ICB seats between a range of professions and disciplines, and giving partner members representing other sectors (e.g. VCSE) a meaningful say in strategy and commissioning decisions.
Efforts are tangibly shifting towards upstream prevention and population health management, with the VCSE sector taking a prominent role.
- In partnership with Manchester University NHS Foundation Trust, Nuffield Health’s Community Champions scheme equips trained volunteers with the knowledge and skills to undertake blood pressure checks for local residents in areas with poor health outcomes. These are available in convenient locations, and patients are directed towards the best available interventions, creating a new hypertension case finding pathway.
- The Prehab4Cancer programme is a rehabilitation service offered in leisure centres across Greater Manchester and aims “to help patients (and their loved ones) to cope with cancer treatment and feel better, physically and mentally.” The programme’s pilot saw 1,000 patients receive holistic care management over a five-month period while awaiting immune-oncological treatment. It led to average 1.4 day length-of-stay reduction, releasing 550 bed days and enabling additional 179 patients to access the care pathway as a result.
- Multidisciplinary teams in North Central London ICS are using combinations of data – from acute and primary care, community health and housing – along with elective recovery waiting lists, to look across care pathways and deliver care to where it will be most impactful.
- Nuffield Health’s joint pain service is provided free of charge to patients awaiting orthopaedic procedures, two-thirds of whom experience improved clinical outcomes as a result.
Since being charged with spearheading a new paradigm for health and care in July 2022, ICSs have shown significant progress despite well-documented, ongoing challenges. Continued collaboration, diversity of perspectives, a focus on prevention, and the ability to derive data-driven insights will further enhance ICSs’ potential to meet the needs of their populations and achieve their four principle aims.
ICSs will continue to be limited in what they can achieve as long as significant national challenges, particularly budgetary and workforce constraints, exist. However, the intrinsic focus on collaboration and consensus-building, combined with a high degree of local autonomy, gives ICSs substantial leeway in how they address these challenges. With concerted effort from all stakeholders, ICSs can continue to mature and deliver real benefits for patients and communities.
In addition to the above, it is also important to note that ICSs are still relatively new entities, and it will take time for them to fully mature and develop effective ways of working with their partners. However, the progress that has been made so far is encouraging, and it is clear that ICSs have the potential to play a significant role in improving the health and care of the population.