By Craig Dearden-Phillips MBE, Managing Director of Social Minds
The new White Paper leaked last week falls so short in its depiction of how integrated local health and care system should function that we are left, yet again, making it up as we go along.
What we get is a mixture of ‘Whitehall-knows-best’ interventionism, a broadside against independent providers and a mandate to force-wed health and social care in localities that still leaves the bride and groom sleeping in separate beds.
So, is this ‘Integration in Name Only’ (or INO for short)?. Yes and no. Yes, in that the sovereignty of the NHS is not particularly compromised by any aspect of integration. No, in that the White Paper does offer scope for imaginative local arrangements to flourish. Which is where, for now, hope has to flourish.
But first, the critique:
1. Un-integrated Governance. Integrated Care Systems are to have not one but two boards. Yes, that’s right TWO boards; one for NHS Providers and another for ‘NHS Care Partnerships’ – to which other key players like local councils, independent providers and the voluntary sector will be invited. This second board is presumably meant as a bridge between the old world of the NHS working alone and the new where there can be a single board encompassing all the key local players, able to oversee a truly integrated system of health and care. However, this begs the question, if integration is the goal, should we not go straight to a one board system rather than keeping the Berlin Wall intact?
2. Beware independent providers. The virtual elimination of competitive tendering for health services could mean the end, in some ICSs, for independent providers who, back in the day, won the right to provide from lacklustre NHS operators. Some of these Trusts have never quite forgiven these renegades – which include the health and care mutuals set up under Right to Request. In the teeth of a resurgent NHS, the challenge for the mutual will be to quickly and successfully answer the question ‘What value do we add in the ICS system?’ – a point to which I return at the end.
3. The Place of ‘Place’. At no point is ‘place’ defined in this White Paper – but the thrust of the document seems to be that distinct local geographies and natural communities are important when it comes to how healthcare is provided. This would suggest that ICSs should seek to operate not as regional entities (covering multiple ‘places’) but as more localised arrangements with rough contiguity around upper-tier council areas (as rough-indicators of place). The challenge however is that the natural unit of organisation for health services is often much bigger than many single local authority areas. Therefore, delegation to place (or subsidiarity), while nice in theory might be hard where you have either one acute trust serving three or four upper-tier council areas (e.g., Mid-Yorkshire serving Wakefield, Kirklees and Calderdale). But without ICS functions delegated to partnerships that are contiguous with local government it is hard to see how integration gets done in the way set out in the White Paper.
What, as providers in health and care, are we to make of this?
The White Paper notes that integration is happening on the ground in many places, often ahead of legislation. In short, we are being told to get on with it. This gives rise to the possibility of devolution of ICS budgets to genuine places and deeper collaborations at place-based level between the NHS, councils and communities so that acute healthcare, social care and population health can be managed as one.
This possibility creates an urgent need for our boards to create, at pace, revised strategies and immediate term business plans for this new agenda. These must ensure our organisations are:
· Highly valued and respected (by PCNs, local councils, health and wellbeing boards and those who will run the ICSs) collaborators at a place level, delivering services in a ‘genuinely place tailored’ way.
· Skilled at deep and imaginative partnerships at both operational and managerial level that produce both better results and financial benefits.
· Successful at making major contributions to strategically important health and care outcomes.
· Very efficient – delivering to outstanding levels of quality with value for money that is higher than is the norm inside the NHS.
· Innovative – verifiably adding significant innovation into the ICS system.
There is actually massive scope here for the best organisations to make things happen on the ground. So, this is no time to wait for Tablets of Stone to tell us what to do.
Le’ts Get Integration Done!
Social Minds is working with Boards of several independent providers to co-create strategies for success in this new environment. Please get in touch if you want to join the conversation.
firstname.lastname@example.org 07764203969 @deardenphillips