New report: Practical care for effective integrated care systems

• Joint working between the NHS and local government must reflect a genuine partnership of equals.
• Those working in the social care sector need to be awarded with status and pay to match that of their NHS colleagues.
• Report launched by Rt Hon Stephen Dorrell, former Secretary of State for Health, Phil Hope, former Minister of State for Care Services and other senior thought leaders including Patricia Hewitt, Independent Chair of Norfolk and Waveney ICS

 

As Parliament debates the Health and Care Bill, a new report from Public Policy Projects (PPP) has called upon Government to place the voice of local government and social care on an equal footing to the NHS. The report comes in response to the Government’s Integration and Innovation white paper and sets out a blueprint for how integrated care reform can be delivered in practice.

Practical action for effective integrated care systems, published on 13th July in partnership with DevoConnect, outlines a series of recommendations to achieve parity between local government and the NHS and address social care with the same vigour as acute care.

The report, co-chaired by Rt Hon Stephen Dorrell, former Secretary of State for Health and Phil Hope, former Minister of State for Care Services, consulted with a range of key stakeholders in Integrated Care Systems (ICSs), local government, public services and across political parties. Two key findings emerged from these evidence sessions: the white paper does not sufficiently prioritise the local government voice and fails to achieve parity of esteem between the NHS and social care.

The report welcomes the commitment of NHS leadership to ensure that NHS services are joined up with other local services. However, there are strong cultural and institutional constraints to this potentially transformational development, the report warns, which needs to be addressed in a sustain way.

It is regretteble that the current draft of the legislation does not provide a statutory basis for the ICS Partnership Board. The former Secretary of State for Health stated that his objective was to strengthen national political control of NHS services. The report recommends that his successor amends the health and care bill to provide a statutory basis for the Health and Care Partnership Board and a statutory framework for partnership budgets which addresses the priorities agreed by the Partnership Board.

The Covid-19 pandemic has raise dramatically the status and value of social care in the public eye. The report recommends that the bill is amended to provide a new framework for social care which includes a commitment to increase funding for social care and arrangements for a Social Care People Plan to match the NHS People Plan.

 

The report identifies a series of key recommendations:

• The decisions of the ICS NHS Board should be compliant with the aims and priorities of the ICS partnership board. Further guidance should be produced on how the ICS NHS board should have due regard to the ICS health and care partnership board health and wellbeing plan, and there should be a statutory duty on the NHS and local government to collaborate.
• The ICS partnership board should be placed on a statutory footing with a duty to plan and deliver a comprehensive health and wellbeing strategy, built on local place-based strategies, to improve population health and reduce health inequalities within its health geography.
• Action by the Government to support parity of esteem between health and social care in general, and parity of earnings in particular, is essential for ICSs to plan and manage their ICS workforce based on the requirements of the local population’s health, social care and public health needs.
• A key step towards integration of the planning and management of local health and social care workforces by ICSs is for the Government to publish a social care people plan that mirrors the NHS People Plan. A further step would be to merge these into a single health and social care people plan to underpin local plans developed by ICSs.

Phil Hope, co-chair of the PPP report, said: “The Health and Care Bill presented to Parliament for debate provides a unique opportunity to build back a fairer health and social care system after the pandemic. But the legislation must create a genuine partnership of equals between the NHS and Local Government to deliver better health and social care services, and reduce health inequalities within our communities.

Failure to do so could lead to a more centralised NHS focused yet again on acute care in hospitals rather than on building local integrated systems which provide better care closer to home and tackle the causes of ill-health in the population.

Our report makes 31 recommendations for developing effective integrated care systems concerning their governance, collaborative working between service providers, system performance and incentives, funding flows, the workforce, digital health and the public estate. Some of these concern changes to the Bill whilst others are suggestions for good practice that every integrated care system could consider in this vital year of their development.

And it will be essential that proposals to reform and fully fund our social care services are brought forward without delay. Those who need social care, and those who provide it, deserve a fair deal and parity of esteem with our health services if we are to create an integrated health and social care system we can all be proud of.”

Commenting on the release of the report, Naomi Eisenstadt, Independent Chair of Northamptonshire ICS said: “The Government’s plans for integrating health and social care are ambitious and should be welcomed. Achieving the core aims of improving health and reducing inequalities in health outcomes is challenging. Making progress will be much more likely if the recommendations in this report are implemented. I am convinced we can improve health by public bodies and the voluntary and independent sector all working together. This wise report should help us in that task.”

Patricia Hewitt, Independent Chair of Norfolk and Waveney ICS said: “With the NHS Bill published last week, this timely report will make a valuable contribution to the debate about how each ICS should take advantage of the great opportunities presented by becoming a statutory system from April 2022.”

Also commenting on the release of the report, Matthew Stickland, Director of Strategy and Communications at TPP said: “Integrated Care Systems have the ability to enable cross-organisation working and new forms of collaboration between the NHS, local governments, and the third sector. This report highlights a number of key practical considerations to help achieve genuinely integrated care across a region.

From a digital health perspective, the recommendations outline the importance of clear digital leadership on the ICS board. In my view, careful consideration is needed when it comes to ICS board representation, in order to move toward a collective responsibility for digital maturity across the whole system.

It is widely recognised that technology can play an important role in facilitating integrated care, providing a better experience for patients, improving outcomes, and supporting the workforce. We need digital systems that genuinely assist staff and facilitate high quality care across an entire ICS. These systems need to interoperate, so that vital data is always available at the point of care. They also need to support data flows for population health and for improved planning. Any systems deployed must be cost effective and leave enough room in the IT budget for investment in people. This is key to ensuring the success of ICSs.”

This programme of work has been written in partnership with DevoConnect. Sponsorship for this report has provided by TPP and Cerner. Public Policy Projects have retained full editorial control.

View and download the report here.