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Health and Care Select Committee accepts PPP report as evidence in integrated care inquiry  

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ICS Futures, Public Policy Projects

The Heath and Care Select Committee has accepted a recent report from Public Policy Projects as evidence in its inquiry to consider how Integrated Care Systems (ICSs) will deliver joined up health and care services to meet the needs of local populations.

The inquiry considers how ICSs will be able to operate with the flexibility and autonomy required in order to tackle inequalities in the populations they serve and whether the pursuit of central targets can be consistent with local autonomy. 

PPP’s report, ICS Futures, examines the decision-making processes of ICSs and how they choose to adapt their services to meet local population needs. The report collates the key findings from three roundtables, each chaired by Matthew Swindells, former Deputy CEO of NHS England current Chair of the North West London NHS Acute Collaborative. Each roundtable convened up to 30 ICS Chairs and key transformation stakeholders. 

The report presents a series of recommendations to both national government and ICS system level leadership across three core topics:  

  • Digital Infrastructure and Health Data 
  • The Development of Primary and Community Health Serivces and Links with Social care
  • Prevention, Early Intervention and Health Inequalities

Ensuring all parts of the sector get a seat at the table

ICS Futures tackles with profound questions relating to system vs place-based decision making, dissecting key issues relating to governance and accountability. The report insists that ICSs should come to represent a ‘partnership of equals’ between different parts of the system, particularly social care.

PPP’s report also found that historic tensions between the subsidiarity of place with aggregation and scale remain prominent across England’s health and care system. ICSs will need to grapple with these challenges in a way that works best for their localities, adopting flexible approaches that allow for system wide direction while not stifling local innovation. 

There remains a lack of awareness among the public, and indeed within the health service, of the full range of care provision available within a locality, whether that be social care, secondary care, primary care, social prescription, or tertiary care. 

The expertise and insight of the social care sector remains an underused resource in driving system transformation and understanding and awareness of social care provision across within ICSs remains low.

Data sharing as a duty of care 

Among the key data findings from ICS Futures is the fact that ICSs are currently grappling with a heavily fragmented data platform landscape, with many competing systems in use. This ‘platform soup’ mentality lacks the cohesion necessary for ICSs to implement population health management approaches. There are many legacy systems, often used previously by individual CCGs, that do not necessarily interoperate with system wide solutions. 

The report recommends that ICBs be empowered to make bold decisions, potentially scrapping old legacy data systems in favour of system-wide interoperability.  

The report does however find that ICSs have made a good start in developing data strategies by creating data analytics teams across the country and that the crisis of Covid-19 has shifted the dial in favour of greater interoperability and data sharing – this is further emphasised by the Inegrated Care Partnership onus on collaboration above competition.

Despite recent progress, the report finds that there remains significant apprehension to data sharing, both among the public and the health and care workforce. Much of this relates to previous lapses in data security (or at least the communications strategies that surrounded them), but also a fear that data will be used for performance management purposes. 

In order to firmly establish the importance of data, ICS Futures recommends that the NHS constitution should be amended to establish data sharing as a duty of care. ICS leadership should work to embed this mentality, both for clinicians using the data, and for the patients and end users on the receiving end of its benefits. 

Health inequality as a tangible objective 

The ICS Network agrees that tackling health inequality must be the central objective of integrated care, and this should be considered a unifying objective across health and care providers. However, there are tensions between aspiration and reality within health inequalities; there is a sense that reporting structures around health inequality have been taken to system level when the truly valuable data can be measured and harnessed at place level. 

Crucial to this discussion is differentiating between determining factors associated with long-term economic inequality and social deprivation against factors well within NHS control, such as inequalities within waiting lists.  ICS Futures asserts that the NHS has yet to fully utilise its potential as an anchor institution. 

In addressing health inequalities, it is vital that ICSs become a coordination point for broad public service integration and not simply a machinery to break down siloes within the NHS. ICBs should look to leverage their position as conveners of key public sector organisations and push for policies that promote economic regeneration and help target deprived and disenfranchised communities. This could include initiatives to push health providers to make prioritised recruitment drives from more deprived areas within their systems, and an onus to not outsource public sector contracts that could hold employment opportunities for local communities. 

For this wave of reform to be successful, ICSs will need to break with historical mistakes, focusing on outcomes over outputs, relationships over structures and above all else, people

Commenting on the launch of the report and its acceptance into the Health and Care Select Committee’s inquiry, David Duffy, Head of Content at Public Policy Projects and co-author of the report alog side PPP Content Editor Gabriel Blaazer said: “Integrated care is not a new concept, and ICSs do not represent the first attempt to join up health and care services. For this wave of reform to be successful, ICSs will need to break with historical mistakes, focusing on outcomes over outputs, relationships over structures and above all else, people. 

“Previous iterations of integrated care have failed to effect significant change because decision makers have not had the tools they needed to drive service reform, or were simply not aware of what was available to them. This lack of awareness is still present within current ICSs structures, partly due to ongoing tensions between aggregation and scale against place-based decision making. 

“We are pleased that our report has been accepted as evidence in the Health and Care select Committee’s latest Inquiry, and we hope to continue to submit further evidence as we travel the country in our ICS Roadshow series, where we are evaluating the progress of integrated care at a localised level.” 

Download the full version of the report here. Alternatively, an executive summary version is now available on the Health and Care Select Committee’s website labelled with reference: ICS0045. 

Across the autumn, PPP will be taking the findings of this report and applying them at a local level. The ICS Roadshow is a series of half day conferences that convenes local stakeholders and system leaders across five different regions across the autumn.