Local Integrated Care Systems (ICSs) in England are to set to receive more powers and funding under a government blueprint designed to speed up the devolution of health and care services to local communities.
The report, Integrating Care – The next steps to building strong and effective integrated care systems across England, published by NHS England and NHS Improvement (NHSE/I) at the end of 2020, sets out plans to devolve functions and resources from national and regional levels to local ICSs from April 2021, and to develop effective models for joined-up working between NHS and social care services. It also outlines proposals to put ICSs on a statutory footing from April 2022.
The proposed changes will allow funding and resources to devolved so decisions about services can be made closer to the communities they serve. ICSs will be expected to work across systems and with collaborative partners to ensure that:
The report describes ‘place’ as the key building block for health and care integration, recognising that most people have a ‘place-based’ understanding of the services they use, and that place-based services are more likely to notice gaps in service provision than regional or nationally planned services. The report also recognises that health and care services, as anchor institutions in their local communities, play a significant role in social and economic development and environmental sustainability.
Providers of primary care, community health and mental health services, social care and support, community diagnostics and urgent and emergency care will be required to work together with delegated budgets to join up services, with delivery built around neighbourhood Primary Care Networks (PCNs).
With hospital, specialist mental health and ambulance services, provider collaboration will sometimes need to be organised at entire ICS-level, or potentially even more widely, the report says.
MiP chief executive Jon Restell welcomed the move to support the emerging ICS model with statutory changes. “Our members support the collaborative systems approach to population health management and service improvement,” he said. “They want to give the model a proper legal underpinning and effective management arrangements. The proposals in this document have been discussed for several years with broad consensus in the NHS, and they would have been taken forward much sooner if it weren’t for the focus on Brexit.
NHSE/I has outlined a series of practical changes to be implemented by April 2021 to drive the development of ICSs across England. These include:
MiP has warned against repeating “the costly distraction and fragmentation of the Lansley reforms” as the new arrangements are put into place. “Managers across the NHS are stretched very thin and need support to continue to deal with operational challenges, not threats of redundancy,” Restell said. “There are opportunities here to re-focus finance, information and planning capabilities on performance and improvement, rather than contracting between providers and commissioning.
“After the Lansley disaster, our members are rightly worried about what’s going to happen. We welcome the announcement of a stable employment guarantee,” he added. National employment frameworks and principles, negotiated with unions, will be vital to make sure the NHS gets the change right.”
While a great deal of policy work can be done within the existing legislative framework, legislation will be necessary to deliver all aspects of the plans. In September 2019, NHSE/I made a number of recommendations for an NHS bill, including:
Two options are being considered for enshrining the ICS system in legislation: a statutory committee model with an Accountable Officer, which binds together current statutory organisations, or a statutory corporate body model which incorporates the statutory functions of CCGs into ICSs.
Both options have both positive and negative aspects. The statutory committee model retains the individual organisational autonomy envisaged when these system changes were first planned, but it’s unclear who would ‘own’ patient outcomes or finances. The statutory corporate model would deliver a clearer structure and, with most commissioning work devolved to ICS level, allow for more place-based working. However, this model requires much more significant changes, which could be difficult to deliver during a pandemic.
“We welcome the fact that NHS England is talking to the NHS about what to do next,” says Restell. “MiP will study the various legislative options and consult our members. It’s so important that members let us know their views as healthcare professionals, so we can represent them and protect their employment interests.”
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