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The Chief Operating Officer of Our Healthier South East London, discusses the journey from Sustainability and Transformation Partnership (STP) to Integrated Care System (ICS):
Here in South East London we are making good progress on creating the capital’s first integrated care system, working out how our complex health economy can be transformed into an ICS and sharing lessons learned with our peers across London.
Ours certainly is a complex system – six clinical commissioning groups – soon to merge into one – six local authorities and five provider trusts, together serving a diverse population of around two million.
We also have numerous voluntary sector partners and support from others who have an interest in our part of London. Some of our Trusts, King’s College Hospital, Guys and St Thomas’ and South London & Maudsley (SLAM), also treat patients from across the UK and beyond.
We call our ICS a ‘system of systems’, recognising that we’re integrating on a number of levels. In addition to partnership working that covers the whole area, we also have partnerships within each of our boroughs – reflecting the ICS structure of neighbourhood, place and system. It’s important that we don’t just badge work that reaches across the entire system as an ICS project, but that we recognise it in all the ways our teams are working closer together, however localised a project may seem.
This multi-level integration was pulled out as a key theme at a session with all our partners in November, which focused on how we are going to work as an ICS and what we are going to do differently. Our aim is to demonstrate from the start that partnership working will be able to deliver the outcomes we want, and to gain confidence from our successes in this new way of working.
We’re already seeing a lot of progress on initiatives that began as part of our STP plans. For example, the One Bromley partnership has improved its support for thousands of patients with complex and long-term conditions, with care plans delivered through a team including GPs, community matrons, specialist hospital consultants, mental health, social care and the third sector. Where initiatives like these are developed at a borough level, we are working to share the good practice across our whole area.
At a wider system level, the acute trusts are already working together on a range of issues, such as how they can network certain key specialties such as orthopaedics and urology to shorten waiting times. We are also seeing exciting developments in cancer care, with the South East London Cancer Alliance introducing a rapid access diagnostic clinic for patients with vague but worrying ‘red flag’ symptoms. The patients see a consultant and have diagnostic tests on the same day, allowing more people to receive early diagnosis of cancer.
Our mental health providers are also collaborating through the South London Partnership to improve care, reduce variation and make the best use of resources and new technology.
The initiatives aren’t all clinical; our Directors of Procurement are looking to improve efficiency by creating a hub for medical supplies and a smart system to cut down on the number of vans running around making deliveries. Not only will we see a more efficient use of resources, we will contribute towards the Mayor’s commitment to reducing air pollution.
We’re also making some organisational changes that we think will give integrated care a real boost. In April 2020, the six current CCGs will merge into one, and this will give us an opportunity to start a new relationship – not sitting on either side of the table as commissioners and providers but taking a much more collaborative approach where contracts are simply a tool to make change happen rather than something that drives the whole planning process.
It is so important to have unhurried, unpressured conversations about how the ICS will develop, so that all the partners in the room can have the time and space to come up with answers together. As an ICS we want more openness, with more information shared across the partners, because with a full and honest view of all our financial positions, our activity levels, health needs data and so on, we will have greater shared ownership of our issues and the potential solutions.
As an ICS we’re not doing anything that no one has ever thought of; it’s more a question of working out how we turn ideas into reality and making sure no one gets left behind, so that right across our patch all our patients have the same quality of care and support to help them stay healthy and well.