Are ICSs bringing the right voices together?
Part one of the ICS Roadshow report recommends that the government should consider broadening the statutory composition of integrated care partnerships to ensure a minimum level of representation to tackle the social determinants of health.
Integrated care system (ICS) leaders have called for the formal inclusion of a broad spectrum of partners in integrated care partnerships, in a report released by PPP. The report, Ensuring ICSs represent a partnership of equals, also recommends that the statutory inclusion of provider collaboratives on ICPs will be essential if ICSs are to effectively make meaningful gains on health inequalities and population health.
These insights and recommendations were gathered from last year’s ICS Roadshow series, which saw ICS leaders and health and care stakeholders debate national and regional integrated care policy in Leeds, London, Birmingham, Bristol and Manchester.
ICS leaders were broadly optimistic that the collaborative and partnership-driven ethos of ICSs has real potential to enable the broad representation of stakeholders who have a positive role to play in population health. However, this is not a given; in its statutory framework for ICSs, the government has taken a ‘minimalist approach’, intended to ensure that the composition of integrated care partnerships (ICPs) is not overly prescriptive, and is flexible enough to reflect the particular needs of local populations.
However, this creates the potential for glaring omissions in the composition of ICBs across the country; for example, it was noted by Dr Justin Varney, Director of Public Health at Birmingham City Council, that “in the creation of ICSs, there was a requirement to have the representation of an NHS provider collaborative”, but no such obligation exists for the social care sector.
“A proper partnership going forward has to have a more structural framework.”
Professor Vic Rayner OBE, Chief Executive, National Care Forum
Pearse Butler, Chair of the South Yorkshire Integrated Care Board, stated a widely-shared opinion at the Roadshow in Leeds, saying “I don’t think an ICB can be remotely successful unless there’s really good partnership arrangements with its local authority and its voluntary sector.”
Chair of the Bristol, North Somerset and South Gloucester ICB, Dr Jeff Farrar, explained how his ICS had worked to achieve real partnership through “inclusive structures” that ensure that as many parts of the system as possible are represented at the top level; “We’ve got a large integrated care board, and we’ve also got a large integrated care partnership”, said Dr Farrar, who added: “we are trying to incorporate VCSEs at all levels.”
Professor Vic Rayner OBE, Chief Executive of the National Care Forum, argued that this inclusion must extend to citizens – the actual service users themselves. Rayner said that “a proper partnership going forward has to have a more structural framework that requires both the voice of the people who are providing services, and indeed, the voice of people who are receiving those services.”
To address this point, the report, therefore, recommends that the government consider broadening the statutory composition of ICPs to ensure a minimum level of representation to tackle the wider social determinants of health.
“Create a voice [that] represents not your organisation, but your profession.”
Yousaf Ahmed, Chief Pharmacist and Director of Medicines Optimisation, Frimley Integrated Care Board
It was acknowledged by most attendees that following such a seismic reform of the health system, it will take time for the different parts of ICSs to become acquainted with one another and adjust to differences in process and culture. Dr Tracey Vell, Associate Lead for Primary and Community Care at Greater Manchester ICS, argued that instituting formal, cross-sector leadership training would “make people around the boardroom understand what [other sectors] are and what they can do, and the restrictions” on them, facilitating better decision making and resource allocation across each ICS.
Accordingly, the report makes the recommendation that ICSs should consider implementing formal, cross-sector leadership training, to ensure that all parts of the system are aware of the capabilities and limitations of the others.
As participants grappled with the question of how to include different partners at the top level of ICSs, the principle emerged that if population health is to be effectively addressed, the default primacy of one sector over the others must be eschewed in favour of creating a ‘partnership of equals’.
Most notably, participants observed that GPs function as the de-facto point of entry into the health system for the vast majority of those in need of healthcare. This dynamic has led to immense pressure on general practice, and could be remedied if ICSs can leverage the full range of assets at their disposal, particularly the VCSE sector.
“The voluntary sector in Greater Manchester has organised itself.”
Sir Richard Leese, Chair, NHS Greater Manchester Integrated Care.
To this end, leaders overwhelmingly agreed that provider sectors and VCSE organisations must organise themselves, creating a unified voice with which they can influence meaningful change at the top levels. Yousaf Ahmed, Chief Pharmacist and Director of Medicines Optimisation at Frimley Integrated Care Board said that this means creating a “voice [that] represents not your organisation, but your profession.”
In his keynote speech in Manchester, Sir Richard Leese, Chair of NHS Manchester Integrated Care, emphasised that “the voluntary sector in Greater Manchester has organised itself. It has a leadership group that went through a competitive appointment process to appoint the partner member on the board of the ICB.”
While the representation of provider collaboratives on ICPs is not obligatory, the report considers this representation essential. As such it recommends that the government consider mandating the formation of provider collaboratives who can provide an elected chair to sit on ICPs, to guarantee the inclusion of providers from a broad spectrum, if only indirectly.
Download the full report here.
Recommendations from the chapter:
- Government should consider broadening the statutory framework of ICPs to ensure a minimum level of representation to tackle the wider social determinants of health.
- ICSs should consider the implementation of formal, cross-sector leadership training, to ensure that all parts of the system are aware of the capabilities and limitations of the others.
- Government should consider mandating the formation of provider collaboratives who can provide an elected chair to sit on ICPs.
- The upcoming Hewitt review should examine CQC’s ability and capacity to regulate cultural changes, as well as encourage greater scrutiny of how ICSs ability to represent a ‘partnership of equals’.