Launched formally in July this year, Integrated Care Systems (ICSs) aim to enhance collaboration between health and care services to better respond to the numerous challenges they face. ICSs are complex and diverse, formed of multiple partnerships between organisations which have historically worked in silos.
Earlier this month, the East of England Local Government Association, Moorhouse Consulting, NHS England (East) and NHS Confederation hosted a webinar gathering health and local government leaders in the East of England to share reflections on the progress made in establishing ICSs and how to accelerate their impact going forward.
The webinar builds on and aligns with a range of recent work in the region focusing on collaboration and is the first of a series of stock-takes to track ICS progress.
Here we share the webinar’s key insights and learnings:
ICSs in the East of England: Tentative first steps
There are signs that ICSs are achieving what they intended to. However, the size of the challenge should not be underestimated.
“Early days, but good emerging signs.”
“The architecture is there; still a way to go for ways of working.”
The architecture to facilitate collaboration between organisations has largely been established – the will and commitment is certainly there. The next priority is to successfully shift relationships and ways of working, and merge different cultures, to maximise this new architecture’s impact. Traditionally, the health and care sector has encouraged competition, rather than collaboration. This shift in mindset will be key and is one that will prove most difficult to overcome among leaders, given how entrenched competition has been in the past.
Great enthusiasm exists for the opportunities ICSs promise in tackling inequalities. There is also real appetite for ICSs, and particularly the NHS, to drive broader social and economic development to improve the health and wellbeing of local communities.
The health inequalities agenda has been making real traction through the support that ICSs offer. The imbalance it seeks to address is stark and not just across health outcomes. For instance, the resident of a deprived area is 2.5 times more likely to attend A&E, often for non-medical services available in a non-acute setting. Leaders pondered how to create the space to invest sufficient time in progressing the inequalities agenda when there are so many other immediate pressures dominating the national direction, such as urgent and emergency care and managing elective backlogs. Use of data, leveraging the role of public health and really investing in a joint health and wellbeing strategy were said to be crucial to managing this tension of priorities.
The value of organisations including hospitals, local authorities and universities was highlighted using the concept of ‘anchor institutions’ – a term developed in the US to describe large, public-sector organisations whose sustainability is tied to the wellbeing of the populations they serve. ‘Anchor’ because such organisations are unlikely to relocate, acting as a permanent and reliable connector to the local population. Hospitals, for example, play a key role in attracting and retaining health and social care staff, helping to support economic development within their geography. The concept of ‘anchor institutions’ could be harnessed to influence the health and wellbeing of local communities: this is a hot topic in the East of England – with a dedicated webinar series focussing on this topic launched only recently.
There is consensus that children’s services should remain at the core of any ICSs strategy. The Covid-19 pandemic has significantly impacted the resilience of families and young people across the UK, exacerbating inequalities, particularly within less affluent regions. Coupled with the complexities of service design and delivery, the partnership models of care within Children’s services’ can teach us a lot about successful system working and collaboration, as well as also being a good test case for innovation.
ICSs in the East of England: what’s next?
The progress made since ICSs were launched lays the groundwork for greater cooperation between health and social care inthe months ahead. The appetite for collaboration is significant, and, together with a deepening understanding of how health and social care, and wider societal challenges interlink, ICS leaders are feeling more empowered to deliver meaningful and sustainable change. We must now shift leadership style, behaviours, and relationships right across the system to optimise the health and functioning of ICSs.
How can systems deliver that shift as quickly as possible? Firstly, ICSs require a new type of leadership to prove their true value as an operating model. If we think of an ICS as a complex ecosystem, they lend themselves more to blended models of leadership, away from more traditional approaches such as hierarchical command and control styles. This does not, however, de-value accountability, which must always prevail even within more blended structures, and has specific complexities when working across the local government sector and the NHS.
“Integration is good, but a blurring of accountability isn’t.”
Secondly, we must cultivate an environment encouraging people to openly talk about their challenges, see these as shared challenges, and share knowledge and experience across teams and organisations. By strengthening interconnectivities between people and their models of working, hierarchies will fade, and co-design will flourish.
“Be serious about spending time getting to know each other and walking in each other’s shoes”
Thirdly, we must ensure ICSs’ organisational development and culture permeates right through the system, vertically and horizontally, both across and within organsational boundaries including in the voluntary sector. This is particularly important as ICSs seek to address a range and possibly misaligned agendas to successfully serve their populations. For example, national NHS mandates alongside Place shaping and leadership strategies from local authorities. Whilst high-level vision and strategy may have been defined, front-line staff will only be in a position to provide more joined up care if they are bought into the vision and understand the strategy (and their role within it).
“[To ensure] all staff can be system operators and not revert to defensive or insular perspectives about their own organisations… Leaders need to create a shared culture of safety, inquiry, humbleness and curiosity.”
“It is the job of leaders to guide staff into system thinking and to bring the wider determinants to bear on all that they do.”
And finally, we must develop a data-driven, population health approach which involves meaningful engagement with residents themselves, particularly in tackling health inequalities. This might be through sharing insights obtained with data and analytics or by inviting residents to explore their own wishes and preferences for ICSs. Councillors are particularly well-placed to gauge population morale and act as passionate advocates for ICS policy. Ultimately, we must find ways to use data across health, careand wider services (e.g. housing or prevention) to secure true visibility across the whole system and embed a holistic approach – whilst acknowledging this is no easy task.
Undoubtedly, ICSs face significant challenges in successfully delivering their four key strategic purposes. Six months on since their inauguration, systems have made some headway in establishing collaborative architectures and securing support from across health and care. Driving change in behaviours to break down long-standing siloes will remain central to system strategy over the months ahead – and the coming winter period, as well as how systems apply the additional investments from the autumn statement collaboratively will provide sure-fire tests of the progress made in developing integrated ways of working across health and social care.
Look out for further webinars and articles on this topic as we follow the progress of ICSs in the East of England over the coming months.