Experts call for ICSs to become “gatekeepers of universal healthcare”
Experts and system leaders, speaking at the Annual Conference for Healthcare and Life Sciences on Monday, stressed that Integrated Care Systems have the potential to redefine place-based care.
When asked about ongoing ICS development, Sir David Sloman, NHS Regional Director for London, gave a cautiously optimistic address, highlighting that the “new infrastructure offered by ICSs will deliver better care and better value for the taxpayer”. While this sentiment was shared across the panel – each speaker including Sir David recognised that the real challenge with integration lies with scaling success.
“ICSs must be designed to push decision making closer to patients,” said Sir David, “there are different levels to defining this place-based approach to care. Primary Care Networks (PCNs) are crucial, but so too is care delivered at borough level, along with provider collaboratives and the ICS structures themselves. ”
Following Sir David’s opening address was Dr Penny Dash, Chair of North West London ICS, who also argued that a combination of borough-based partnerships, PCNs, local authorities and community care would help redefine place-based care.
Dr Dash also highlighted the role of the voluntary sector in delivering place-based care. The 50,000 ICS workforce that makes up NW London ICS is matched by a volunteer force of equal size. “How we as an ICS work with the wider community is absolutely crucial, as this is where the overwhelming majority of changes will occur. ”
Building on these themes, Professor Rebecca Malby, a Professor in Health Systems Innovation at London South Bank University, called upon system leaders and policymakers to properly define what place means in relation to integrated care – whether this is at PCN level, borough level or otherwise. “The ICS should be considered the gatekeeper of universal healthcare,” explained the Professor.
"We are not honest about the impact poverty is having on NHS service demand"
Professor Malby also called upon system leaders and policymakers to be honest about what is driving service demand. Poverty, she said, was driving 40 per cent of primary care attendance, “we are not honest about the impact poverty is having on NHS service demand, we need to be frank about this”.
Establishing the origins of service demand should be one of the defining principles of developing integrated care.
The “prize” of social care integration
For Mike Bell, Chair of Croydon Health Services NHS Trust, “place” in its relation to integrated care in London should always be considered at borough level, as it is here where “the footprints of social care” can be measured. While highlighting how integrating all parts of the health and care system would bring substantial public health benefits, Mr Bell argued that the “biggest prize” for integrated lay in connecting the social care sector with the wider system.
Health and care providers across Croydon have undergone a rapid shift towards integrated care in recent years - the results of this can be seen in the success of the borough's response to Covid-19.
"This is a clear example of the seismic impact that real scale health and care integration can have"
Mike explained that one in five London based care homes reside in Croydon (one of London's largest boroughs) and yet, throughout the pandemic, only one in 20 deaths seen across London’s care homes occurred in Croydon. “This is a clear example of the seismic impact that real scale health and care integration can have,” added Mr Bell.
Addressing health inequalities was a dominant theme throughout the discussion, and indeed throughout the wider conference. It is hoped that ICSs can address what Mike Bell described as “stark” levels of health outcome disparities across the country.
Providing a legal perspective, Robert McGough, Head of Health Commercial, Regulatory and Real Estate for Hill Dickinson, said that the unequal progress of ICS formation currently seen across the country would need to be addressed before integration can bring transformational benefits to the wider system.
“While the pace of change seen in some parts of the UK is good, with many Integrated Care Boards coming together fairly quickly – the same cannot be said in other regions, where some systems have yet to appoint chairs. ” Mitigating this unequal impact, said Mr McGough, was the fact that many providers are taking matters into their own hands and integrating under their own initiative.
The Annual Conference for Healthcare and Life Sciences was the first Public Policy Projects event to be held in person since the start of the Covid-19 pandemic. Over 300 senior leaders from across health, care and life sciences came together to discuss profound challenges facing health and care and to put forward actionable insights to address them.
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