The challenge facing health and care means no one organisation can address them alone. The only way to tackle issues like winter pressures and health inequalities is through collective effort.
Integrated care systems (ICSs) are the right structures to do this. Our Integrated care strategy and Integrated health and care delivery plan have been co-developed with local authorities and partners, with priorities shaped by local communities; they allow us to focus our activity and provide a clear point of reference during conversations. The statutory format helps but it’s really about effort from everybody to make it work.
Our first year as an ICS has been both challenging and rewarding. We are focusing on what can we do to help people start well, live well and age well and help people live independently as long as they can.
One of our biggest achievements this year has been improving services for people with autism by working collectively with local councils, experts by experience, voluntary sector and mental health trusts. We have a long way to go, particularly in helping those who need the most intense support, but the time that young people spend on a waiting list for Autism diagnosis has reduced, which I am proud of.
This year we have looked to create one budget for the whole system rather than for each organisation, to give us the best value for money and ensure our partners are supporting each other.
Our strength as an ICS lies not only in system-wide working but with our collaborative structure which enables us to focus on the priorities of local communities. We have two geographic Care Collaboratives, one for Warwickshire and one for Coventry, as well as four service area Collaboratives, focusing on Mental Health, Learning Disabilities and Autism, Acute and Primary Care respectively. Collaboratives bring providers together to achieve the benefits of working at scale, improving quality, efficiency and outcomes.
Each of our Collaboratives has chosen a different focus, based on local need. In Warwickshire our frailty service prevents half of patients who have had a fall being admitted to hospital. When paramedics visit someone who has had a fall, they can call a frailty phone for advice from frailty consultants and Advanced Care Practitioners. Every discharged patient over the age of 75 is called by a nurse and to support the service, a partnership with Warwickshire Fire and Rescue means they are assessing the risk of slips, trips and falls and bringing food bags to patients’ homes, to prevent them going back to hospital.
In Coventry, the ‘Improving Lives as People’ programme, which provides personalised care for people at risk of admission or illness helps people live independently at home and reduces cost. Before ICSs, there was a lot of silo working, with uncertainty between organisations about who is responsible for what. The first task of the Coventry Care Collaborative is to move the money and decisions to the organisations that deliver care, so that we can make the right decisions irrespective of which organisation you work for.
A key challenge is ensuring that we continue to work together as a whole system and avoid the risk that by accident or design we revert to working as individuals, not partners. When I hear people saying, “what’s the system doing about it?” I remind them “we are all the system.”
The challenge is to be ‘system first’ and holding that through difficult times. Money is always going to be a challenge. Inflation is rising, our population is growing, so we need a common response and collective approach to meet that.
Looking ahead to the next 12 months, we are working with local authorities to look at how we get the most value out of the public pound. We want to formally devolve some of our responsibilities to local community groups and implement more of our wider inequalities plan.
Before ICSs, I would not have seen local employment as something I was involved with but now, we are working with schools, colleges, and universities to get 600 people from deprived backgrounds into employment.
People in our most deprived areas can now get welfare advice in their local GP practice provided by a partnership of voluntary sector organisations and law students from local universities. We want to strengthen that further if possible.
As we celebrate 75 years of the NHS this year, we recognise that the health service needs to keep changing to reflect the needs of the population that it serves, which is very different today to the population in 1948.The move to ICSs genuinely recognises that we need to do things differently. While we long have talked about inequality in the health service, this is the first time we have made a statutory step to recognise it front and centre.
We can play our part in reducing inequality by helping children stay in school, by keeping people fit to work and by maximising independence in later life, and by addressing issues like employment and skills. ICSs will stand or fail by whether we collectively manage to do these things, and that’s my aim for the next 12 months.