Integrating care

“Integrated care systems (ICSs) represent the best opportunity in a generation for a transformation in our health and care system.”

The executive summary from The Rt Hon Patricia Hewitt’s review into integrated care systems leads with that bold vision of the future of health provision within the UK. However, the subsequent sentences carry a warning to the effect that effective change will require new structures and changed cultures in which “everyone needs to change, and everyone needs to play their part.”

With local government, social care providers, community and other organisations all linking together with NHS services; integrated care systems are designed to improve the lives of local people; helping them to live healthy and independent lives through the provision of support at the point of need. With so many organisations all coming together to provide that support, there is though a danger that silo practices or too narrow a focus on delivery could get in the way of the project.

That is why the review was so important; identifying best practices and potential points of failure. To that end, the review has identified six key areas which will need to be addressed in order to deliver thriving integrated care systems. These are:

  • collaboration within and between systems and national bodies;
  • a limited number of shared priorities;
  • allowing local leaders the space and time to lead;
  • the right support;
  • balancing freedom with accountability; and
  • enabling access to timely, transparent and high-quality data.

That last area of focus has also highlighted the importance of the use of data and data management which is relevant and timely. One of the conclusions of the report is that an excessive focus on targets can in fact lead to poorer patient outcomes. That is because leaders are focused more on ‘gaming the system’ in order to meet targets rather than in finding ways to provide viable treatment plans for individuals. Accordingly the report recommends that there be a significant cut in the number of national targets with integrated care systems instead introducing a suite of priorities based on local need.

The report also strongly promotes the provision of integrated approaches which look towards holistic healthcare and prevention. Commenting that ‘for too long we have mistaken NHS policy for healthcare policy’ the report cites an initiative which looked to support physical activity and address social isolation in Wigan. So successful was this community-led initiative that it resulted in a seven-year increase in life expectancy in the most deprived wards in Wigan. It’s an example of the way in which a simple step outside of core health provision can result in a significant improvement in health outcomes.

Commenting on the report the Chair of the Health and Social Care Committee Steve Brine MP said: 

“This is a key moment for Ministers and for NHS England. We have found genuine enthusiasm for the potential of Integrated Care Systems to make a real change, not only in how health and social care is delivered but in prioritising the needs of local populations and preventing ill-health.”