David McKinney, Local Government Managing Director at Servelec, argues that Integrated Care Systems (ICS) will fall at the first hurdle if local authorities aren’t viewed and treated as equal partners
To make something happen, you need two things: the need and the belief. The need for health and social care to integrate is undisputed, with buy-in from stakeholders across the board. And the past 12+ months of lived experience through the pandemic has given us the belief that we can pull together to make it happen. We’ve undergone a mindset shift from ‘you can’t do that’ to ‘how can we make it happen?’.
However, if we look to Scotland, which legislated for more integrated health and care over five years ago, it’s still grappling with exactly that. A recent briefing published by the Scottish Parliament’s research body confirmed there hasn’t been a major shift of money from hospitals into social care or community; nor have the underlying structures or operation of health and social care changed.
In theory, we have all the things we need in place for Integrated Care Systems (ICS) to be successful. But we’re picking up early warning signs that local authorities are being left out in the cold while the healthcare side forges ahead. It’s important we stop and think about how we can tackle these problems and stop ICS joining the scrap pile of failed initiatives. So where should we start?
Level the playing field
The pandemic has been a great leveller, demonstrating time and again how intrinsically linked health and social care are. With their inter-dependency now recognised, it’s high time they are treated as equals. Inclusivity of stakeholders across the board, each bringing valuable perspective to the mix, will be key to the success of ICS. Local authorities need to be viewed and treated as partners from the outset while ICS are being established, or they are destined to fail.
This inclusivity extends to other partners, such as tech suppliers, who will support the whole ICS eco-system. We’re undertaking a mapping exercise with customers, working together to understand the needs and identify the best solutions for the job, and this type of work should feed into how ICS are set up. It will come as no surprise that the ability to share data, to create a joined-up view of a person and their journey through the health and care system, is seen as critical.
Data sharing often ends up on the ‘too difficult’ pile, but the advent of ICS means we need to be able to transfer it securely. There is of course rightly much discussion around data protection and regulation, but what’s become clear is that most people just want access to the right care and services, and in that context, they are broadly happy for their data to be shared.
Getting back to basics
Chief Executive of NHS England, Sir Simon Stevens, recently said that the ICS restructure will be ‘simple, local and evolutionary’. It’s great to have these aspirations, but now’s the time to get back to basics: how are we actually going to make it happen?
ICS are a long-overdue attempt to force closer working between health and social care; how quickly and effectively we are able to achieve this will largely depend on how difficult we try to make it. The task of bringing together the complex web of organisations that exist across health and social care is a daunting one, but it could far too easily succumb to red tape and bureaucracy if we let it. Over-complicating things could well be our downfall.
Tackling the fundamentals – from the financials to the data sharing – while acknowledging that not every trust or local authority is the same, is a delicate balancing act, but one worth investing time and effort in now. A blended approach that allows for localisation, and importantly, gives local government a voice, will help establish ICS for longevity.
A golden opportunity
If ICS are to succeed, we need to envisage what we want our health and care system to look like in 20 years’ time, while keeping our eyes firmly on the fundamentals in the here and now. Having the strategy in place is key. We know what we’re going to do, but we now need to focus on how we’re going to do it, and this is where I believe there’s still a disconnect – especially when it comes to making sure local government is heard.
This recent King’s Fund blog speaks of ICS as a golden opportunity to reset the relationship between health services and the public and argues that rather than just linking up institutions, they should help facilitate a more active relationship between service and communities. For that to truly take shape, we need to reset the relationship between trusts and local government, in recognition of the equally important role they both play.