ICS Summit 2019 - System leaders optimistic but realistic about prospects for integrated care

20 June 2019

Integrated care systems (ICS) are developing fast, as NHS organisations push on to meet the NHS Long Term Plan’s ambitions for complete coverage by April 2021. System leaders gathered at an ICS Summit in London this week to review progress and debate the remaining challenges, as NHS England prepares to announce the next wave of ICS areas.

Speakers from around the country shared local and regional examples of system-working and collaboration, underlining that whatever the other drivers of change, integration is only legitimate if it results in better services for patients and better value for money for taxpayers.

The event, held at the Royal College of GPs in London, was organised by Hill Dickinson in partnership with PCC, IBM Watson and North or England Commissioning Support Unit (NECS).

PCC chair and former national director of primary care Professor David Colin-Thomé acknowledged the economic and workforce pressures driving integration, but said: “Integration isn’t worth a damn if it doesn’t make a difference to patients.”  He warned that that “unless the neighbourhood layer represented by primary care networks is built on a strong foundation, and unless these networks are truly accountable to patients, none of the other architecture will be viable”.           

Dominic Hardy, director of primary care and system transformation and NHS England and NHS Improvement, promised that system leaders would have the backing of national bodies to progress their integrated care programmes. He acknowledged that the long-term plan’s ambition for national coverage by 2021 was “quite a bold statement” but reminded delegates of the imperatives for change.

”Health needs are changing fast and addressing them is a challenge, whether it’s the increasing burden of disease, whether it’s long-term conditions, physical health or mental health. The number of people living to over 85 is going to more than double by 2035. That’s a really seismic change in our demographic profile. Individual organisations can actually do so much across both health and care. Successful and sustainable solutions require people to step beyond their own organisational boundaries and work in concert to address those needs.”

The 14 existing ICS, many of which were already working in some form years before the publication of the long-term plan, were already bearing fruit, he said. Some had been working together for decades “but equally heartening is those systems that have come together relatively recently and to see the strides that they are making”. Hardy added that NHS England and Improvement would shortly announce a further wave of ICS.

He reminded delegates of the five challenges set out in the long-term plan: “To boost primary and community services and dissolve the historic divide between them; redesign and reduce pressure on emergency hospital care; to ensure more personalised care, particularly for those with long-term conditions; to ensure that digitally enabled primary care and outpatient services go mainstream; and to focus on population health as a core function of integrated care systems.”

The summit raised a number of other challenges that still need to be overcome around legislation and regulation, cultural and practical aspects of collaboration, perceived self-interest, funding and payment arrangements, and engagement with the public, whose support or dissent could be critical.

Rob McGough, partner with Hill Dickinson, reminded delegates that in a legal sense “ICS do not exist but depend on co-operation of bodies with different statutory obligations, funding and governance”. This legal ambiguity may require potentially complex agreements and governance arrangements, making decisions harder to take.

NHS England’s Hardy reiterated the commitment made in the NHS Long Term Plan to press the government to remove legislative barriers to integrated care. Many of the pioneering ICS areas admitted to bending the existing rules. All agreed they would prefer the rules to change to make taking such risks unnecessary.

Dr Leigh Griffin, IBM Watson Health Consulting, acknowledged the scepticism of those who might feel that the “latest drive for integrated care is simply old wine in new bottles”. 

“We are in a different time, there is an opportunity for a massive step change. We have an enabling policy framework in the long-term plan, and a strong desire to shift from competitive ways of working to more collaborative ways. There is real excitement around place and neighbourhood approaches – geographies that are relevant to people and make sense to people,” he said.

Speakers agreed that for population health to succeed – defined by one simply as “a shift in approach from treating to preventing illness” –required collaboration both at local and at system level. 

Warren Heppolette, executive lead for strategy in the Greater Manchester Health and Social Care Partnership, which covers a population of 2.8 million explained why some changes could only be delivered at large-scale.

“We’re a £6bn health economy within a £22bn public services economy. We’ve just announced a half a billion pound investment in a walking and cycling infrastructure across Greater Manchester. That couldn’t have happened with ten different conversations with ten different directors of public health.”

Speakers from NECS explained how population health could be managed by applying data and tools to the problem. They presented evidence to show how data on risk factors had been used to reduce dramatically the prevalence of coronary heart disease in the north-east, but warned that these benefits were only sustainable if the system continued to work together.

Stephen Childs, managing director of NECS, said: “We’re in better shape today in some respects with the commitments in the Long Term Plan, but in other respects we’re in a weaker position. There is a lingering distrust amongst our local authority colleagues because of the levels of engagement and lack of transparency when introducing the sustainability and transformation plans. We find public health teams somewhat detached and we operate around a legislative framework designed for anything but integration.

“And we still have some familiar challenges including the conviction and courage of leaders to put the system first knowing that their personal reputation and future employment prospects rest on the fortunes of their organisation, not necessarily the system that they operate in.” 

A cautionary note was sounded in last of the day’s panel sessions by Stephen Dorrell, former chair of the Commons select committee on health, who said: “I’ve heard speeches on these themes from Aneurin Bevan, who died before I was born.”

It was a comment delivered with sympathy, not irony.

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