This post is the first in a series about the future state of health & care, based on our experiences delivering transformation with partner organisations and interviews with senior colleagues. This post explores the opportunities and challenges posed by the introduction of integrated care systems (ICSs) at a local level.
Health and care integration is a hot topic. Despite a string of national policy positions, local governance arrangements and partnership agreements, it remains a difficult challenge. Without proper funding for social care, and a local authority voice at the table, embedding strong health and care integration risks being a promise that cannot be effectively delivered. And what is delivered, done so solely through an acute perspective.
True integration will require fundamental shifts to developing shared visions and collaborative approaches that meet the rising demand of people’s expectations and increasingly complex needs.
Delivering on strategic intent
The latest mechanism for achieving seamless health and care provision is the introduction of Integrated Care Systems (ICS). Set out by the NHS Long Term Plan, from April 2021 all parts of England are covered by 42 ICSs, with some of these having been established since 2018.
Replacing the existing Sustainability & Transformation Partnerships, it appears ICSs are already facing the same problems, despite their new structure. Namely, a confusing geographic footprint, crowded local governance structure and unclear long-term finances. With this comes important structural questions about funding, leadership, decision-making and local accountability.
Over the last five years, we’ve seen local areas adopting different, innovative methods and approaches to address those challenges. This has included structural integration in places like North East Lincolnshire and Trafford who’ve each appointed joint Chief Executives for the Councils and CCGs. But also the work of the local Health & Wellbeing Boards to produce their needs assessments and the closer day-to-day working arrangements in local areas in light of the pandemic response.
However, there still exists a feeling of inequality between local authorities and CCGs across much of the UK. There’s a genuine concern that the new arrangements risk exacerbating the health focus of the wider system.
Primarily, this is a question of both scale and funding.