By Dorothy Oxley
From July 2022 (subject to the passage
of legislation), Clinical Commissioning Groups, which have been responsible for deciding how NHS funds will be spent on health care in their areas, will legally cease to exist. They will be replaced by Integrated Care Boards – in our case, NHS South East London Integrated Care Board
(ICB), which will cover Bexley, Bromley, Greenwich, Lambeth, Lewisham and Southwark and will sit within the Integrated Care System (ICS) for this area of London.
At present, if you’re ill or need care, help can come through a complex mix of services. The ‘Integrated Care System’
(ICS) aims to be a true partnership of all
the organisations contributing to the health and care of people in South East London, bringing together representatives from local authorities, hospitals, primary care and community based services and voluntary organisations and drawing on their various skills and knowledge to design better services. Some positive moves towards better integration have already been made, and the response to the Covid pandemic proved the value of partnership working.
The ICS also recognises the impact of such issues as housing, poverty, transport, education and skills and will look at how people can be supported to live healthier lifestyles. This opens up a huge area of partnership to include the voices of local people and communities.
I attended a webinar about the ICS for local people, and would like to share with you a precis of the questions raised and answered there.
Question: The role of social care in the new structure
: Social care can be a very complex area, and patients and carers are often left to navigate the maze of NHS and social care provision for themselves. How will the new system help?
Bringing the various organisations together will hopefully lead to a more streamlined, clear and flexible support pathway for everyone.
Question: Who is the Integrated Care System accountable to and how can patients be represented on the ICS Board?
The ICS will be accountable to national and local Government, and all partner organisations have agreed that the Board needs to also be accountable to the public, communicating with and engaging local people, including those who are often overlooked, such as people with learning disabilities and young people.
Question: How does the ICS work with private sector companies?
: The members of the Integrated Care Board all come from the statutory (NHS or Local Authority) services or voluntary sector services; places aren’t open to those from the private sector, though private sector provision may be commissioned in health and social care.
Question: How will decisions be made on funding priorities and will it change these?
: There will be a single allocation of funds and a set of principles to deploy them, involving partners and providers directly in how money is being spent. The focus will not be on individual organisations’ activities but on the health needs of people in the region; the NHS nationally is steering towards more ‘out of hospital’ investment. Finances will, however, remain a challenge.
Question: How will these changes help to address workforce issues?
: This is a big challenge, especially in terms of morale, and attracting and keeping good staff will depend in a large part on treating them well. There needs to be good collaboration and employment opportunities that will attract people in. The ICS has a clear commitment to equality, diversity and inclusion in its approach.
Question: How can the Integrated Care System work effectively with unpaid carers?
This is one group whose views need to be heard better, which means looking at different structures and ways of doing things, for example, engaging with people in their local area, arranging meetings between clinical staff, patients and carers, and perhaps paying for their time. It’s also vital to demonstrate that the system has listened and made changes as a result.
Question: How is the vision and mission of the new Integrated Care Board different to what’s been done in South East London for many years?
Yes, there has been some increased partnership working in recent years, but there’s now a need to think how much the health services can do in partnership, and how best to bring in social care colleagues, the voluntary sector, and the wider community as well. The creation of the Integrated Care System and Board
will also give a legal foundation to partnership working.
Question: How will commissioning change?
The practical processes of commissioning won’t change that much. What will change is that in the past, there’s been too much focus on competition, and the activities of individual institutions, rather than what they might do together to meet the needs of a population. The emphasis going forward will be on working in a multi-disciplinary way with providers that give front line care, and on value-based commissioning outcomes. But there’s unlikely to be a seismic change; it will be a continuing process.
Question: How will the ICS communicate and engage with local people?
An engagement platform has also been created, (https://letstalkhealthandcareselondon.org/
) . Let’s Talk Health and Care in South East London is an online community for local people to share their ideas, discuss important topics, provide feedback and help people live healthier lives. You can sign up to the site and give the ICS your views on local projects, your own experiences and what is important to you in terms of health and social care, so please do join the conversation at (https://letstalkhealthandcareselondon.org/conversations
). A new ICC website is also being developed. But not everyone is able to use information technology, so there will also be stakeholder bulletins and partner newsletters, and engagement with local communities through community groups and trusted organisations, going to where people meet and congregate. Other suggestions will be welcome.