Dedicated mental health staff to help children and young people in GP practices, and blood pressure checks in betting shops, are among initiatives devised and delivered by new integrated care systems that come fully into force today.
Boosting health checks in the community to find people with health problems before they become seriously unwell is a key goal of the shift to integrated care systems, where local organisations work together to better meet the needs of local people.
From today, 42 statutory integrated care systems will bring together GP teams, hospitals, local authorities, and other partners to plan and deliver health and care services in their area.
With mental health services for children experiencing record demand, new roles, including wellbeing practitioners, will be in place for local practices to support young people and help with access to local mental health teams. As well as expanding capacity through new roles, GP teams can develop special interests and access training in specific areas such as eating disorders.
A GP practice in Stockport is already going into betting shops to deliver blood pressure checks, identifying and preventing hypertension issues before people end up in hospital.
In Coventry and North Warwickshire, a local sports club offers diabetes and weight management support, taking referrals from GP teams but also reaching out to people in the local area they think might be most at-risk. People can receive tailored one to one diet and lifestyle support, and access to the club’s gym facilities.
And thanks to these local authority partnerships in Bedfordshire, patients who frequently call 999 but do not need emergency help are given alternative “lifesaving” support in their community, ensuring peoples’ needs are met as well as freeing up staff time to deal with emergency calls.
Amanda Pritchard, NHS chief executive, said the changes had the “power to completely transform health and care for people in their local communities” as well as cutting red tape within the NHS and saving taxpayers’ money.
The changes are set to save an estimated £14 million each year by reducing the number of chief executives working in the NHS by almost 170.
New systems are already proving to be an effective tool in tackling the covid backlogs, with eight systems reducing two-year waiters to single figures ahead of the end of July target. Nationally, there are 70% fewer two-year waiters than in January.
Amanda Pritchard, NHS chief executive, said: “Integrated care systems have the power to truly transform the way that we care for people up and down the country – not only will the NHS provide care when someone is unwell or has an accident but alongside our local government partners, we must also now play an increasing key role in managing peoples’ health so that we can catch more killer conditions earlier and save lives.
“Local areas are already doing this by going out into communities to spot signs and symptoms earlier in places such as sports clubs and betting shops as well as ensuring people can access community support rather than using 999 or going to A&E.
“Through these schemes, we are already making a massive difference to peoples’ lives. The NHS will now build on this success and innovation and deliver care for patients that is fit for the future as well as saving taxpayers’ millions of pounds each year”.
Health and Social Care Secretary Sajid Javid said: “We have learned many lessons during the pandemic, particularly following our hugely successful COVID vaccine roll-out, and one of these is that a more joined-up health and care system can help thousands more people get the care they need in the right place at the right time.
“Our Health and Care Act has now established Integrated Care Systems in law, boosting access to care for patients by removing barriers to joint-working, supporting innovative local solutions and giving local leaders more freedom to rapidly fix the issues that matter most to patients.
“I’m hugely grateful to the staff already driving life-saving initiatives in their communities through these new systems, helping to tackle disparities across the country and bust the COVID backlogs”.
Jane, who used to ring 999 or her GP every day in Bedfordshire, was identified as someone needing additional support. When Jane was approached by Victoria from the local social prescribing team, Victoria made simple alterations to her living conditions that dramatically improved her health and wellbeing.
Jane said: “Before I didn’t know who to call or speak to so I would call the GP or 999 if I was worried. Because Vicky came to see me, she was able to really see what my life was like and offered to help me.
“She worked with the council for repairs to my flat, she looked at my benefits and helped me to claim so I have been able to make more improvements to my home. I’m exercising now and going out socially which I didn’t do before, I have even made some new friends.
“Now I know who to call if I’m worried or I don’t understand something, working with this service via my GP has made my life easier, better and happier – I like me now”.
Lincolnshire ICS brought together acute, community and mental health teams to reform local stroke services, helping patients with rehabilitation in their own home earlier and using digital solutions. As a result, they have seen the average length of stay for stroke patients in hospital fall from 13 days to just four and a half.
The linking up of systems is also playing a key role in bringing down elective backlogs, with the Croydon Elective Centre seeing around 300 patients every week from across South West London ICS – a 10% increase on pre-pandemic levels.
The site has seen around 2,000 patients from neighbouring trusts with its own entrance, operating theatres and inpatient wards which were ‘COVID-protected’ during the pandemic to enable it to continue powering though backlogs.
Today also marks another significant change, as NHS England & NHS Improvement becomes NHS England. The two organisations initially merged in April 2019.
While as part of the vital work to better integrate health and social care, the Health and Care Act also extends hospital discharge rights for patients and carers – including young carers for the first time. The act will ensure hospital trusts involve patients and carers in hospital discharge decisions when further care and support is needed and where appropriate.
Saffron Cordery, interim chief executive of NHS Providers, said: “Trust leaders know that the future lies in system working. Amid the many challenges facing health services today, working more closely with partner services presents opportunities to deliver better, more joined-up care for patients.
“Joint working in systems will help the whole of the NHS to tackle inequalities and address deep-rooted disparities in people’s health and wellbeing across England”.
Louise Ansari, national director at Healthwatch England said: “The introduction of Integrated Care Systems gives us a unique chance to feed people’s views into the planning and running of services.
“For instance, we know there’s a desire among the public to see services closer to where people live, making them more accessible and truly at the heart of communities. When services act on the experiences of those they serve, it results in better care.
“We are committed to playing our part, helping create a true partnership between services and the public. A partnership where communities are represented at every level of decision-making, those facing the greatest inequalities are heard and there is an ongoing conversation about how we can make care better together.”
Sarah Walter, director of the NHS Confederation’s ICS Network, said: “This is an important milestone in the development of the health and care service and our ICS leader members are raring to go to make a real difference for the communities that they serve.
“By bringing together system partners including the NHS, local authorities, and the voluntary sector as Integrated Care Systems we are creating much broader partnerships that will be focused on improving population health and tackling the fundamental causes of ill health, whether it be poor housing or isolation.
“Good health should not be the privilege of the rich, it should be for all, and ICS leaders are committed to addressing health inequalities and working together to improve the health of their population”.
Cllr David Fothergill, chairman of the Local Government Association’s Community Wellbeing Board, said: “Integrating health and care has the power to transform how, and how well we deliver these services to residents.
“Integrated Care Systems will allow local authorities and the NHS to pool their wealth of skills and local knowledge to ensure people are receiving, appropriate, timely and effective care. But integration is not an end in itself – it is the most effective means by which we achieve better health outcomes for our communities”.
“Access to comprehensive primary care is vital to the wellbeing of people and communities, and we look forward to working together with the NHS to provide the best services for residents”.
Professor Martin Green OBE, chief executive of Care England, said: “Care England welcomes the establishment of ICSs. ICSs represent the latest initiative aimed at tackling the integration agenda.
“We hope that these new systems will prove successful in integrating health and social care services and creating a joined-up approach to the delivery of care. For true integration to succeed, adult social care providers must have their voices heard at every level.
“We encourage all system leaders to reach out to all local care providers and outline how they can be involved in improving the health and well-being of local people and their communities.”
Professor Vic Rayner OBE, chief executive of the National Care Forum, said: “It is excellent to see that one outcome of this reform will be that health systems are challenging themselves to reshape in line with social care delivery in order to enable people to get an integrated health and care experience in their own front room.
“We’d like to see social care providers playing a central role, alongside other local partners, to shape and deliver the health and social care services people want and need both now and in the future”.
Sir Richard Leese, chair of NHS Greater Manchester Integrated Care, said: “With our unique devolution arrangements, Greater Manchester became England’s first integrated care system in 2016. This was the start of our five-year strategic plan, ‘Taking Charge of our Health and Social Care’, making big improvements to health and care services here. It was instrumental in shaping the design of new national partnerships to support local health and care needs right across England.
“Although a great deal has been achieved in Greater Manchester from voluntary and collaborative working, the new Health and Care Act will help break down further structural barriers and organisational silos to better address the root causes of ill health such as debt, poverty, poor housing and work.
“I’m confident these changes will help embed true joined-up working and ensure public engagement is front and centre when setting big plans”.
Dr Priya Singh, chair of Frimley’s Integrated Care Board, said: “ We are looking forward to working together as partners across all public services, voluntary organisations and communities, to create a shared approach to improving the outcomes and experience of our population and spending the Frimley pound well.
“These changes create a unique opportunity to make a collective difference for both the people we serve and those working tirelessly in delivering services for everyone in our geography.”
Rob Webster, chief executive of West Yorkshire Health and Care Partnership, said: “These arrangements recognise that the NHS can only succeed if it works with citizens, councils, charities, and other organisations based in our communities.
“We need to join up care and focus on the wider determinants of health if we are to improve outcomes, particularly for those in our poorer communities, those facing prejudice and people with learning disabilities or serious mental illness.
“Over the past six years, the West Yorkshire Health and Care Partnership has been successful in developing positive work during times of austerity and the pandemic. The statutory Integrated Care Partnership and the Integrated Care Board are further steps towards cementing this way of working, as we address the impact of the pandemic on staff, services and citizens”.