Integrated Care

Over the last few years in Lancashire and South Cumbria, a number of organisations have been working in a more collaborative way. This includes NHS organisations, local authorities, the voluntary, community, faith and social enterprise (VCFSE) sector and local universities.

We have already made great progress in improving the way our services work together and how we work as a partnership.

As part of these developments we wanted to produce some narrative documents as early as possible to explain how the partners are working together to move towards delivering more integrated care across Lancashire and South Cumbria, which you can see below. 

There’s plenty that we can say about what’s happening and how we are making progress, but there’s also some of the detail that we don’t know yet. Some of this will depend on decisions that are yet to be made nationally, however our vision, purpose and reasons for moving to this way of working won’t change.

A glossary is available to help with language and terminology you may find on these pages.


[Mr Andy Curran]:

Within Lancashire and South Cumbria it's really important we have an integrated health and care and social care partnership.

[Dr Amanda Doyle]:

Demand is continually outstripping our ability to deliver care.

So we're getting more and more demand for health and care services and we're unable to ramp up supply in a way that we can meet that demand.

One of the solutions to that problem is to integrate care. So that instead of all of our organisations  working in isolation, we bring them together, we integrate things.

So that we deliver services more clinically effectively but also cost effectively.

[Andrew Bennett]:

Integrated care is just a way of saying joined up care, and I think what we're trying to do as a group of organisations is make sure that people when they're going through the healthcare system feel like their care is joined up.

[Dr Amanda Doyle]:

Organisations are working collaboratively so that the whole is more than the sum of the parts.

[Karen Partington]:

So I think by coming together, it helps us understand the pressures across the system, but also to pool our ideas, our innovative solutions together so that we can move forward.

[Mr Andy Curran]:

Co-designing the services that we deliver is really important. Knowing what's important to our population. What they value. Is it having access to their own GP twenty four hours a day, or is it having immediate access to someone on an app? Everyone's going to want something different.

[Talib Yaseen]:

It's about a mindset. What could we do differently? How do we learn from other people across England, or elsewhere in the world that have got really well organised services but done in a different way to the way that we do that?

[Gary Raphael]:

We've all got a stake in the performance of all of our organisations. In the way that we might share staff, the way we might organise the way that pathways work. How we share our expertise. Making sure that the good practice in some areas is shared across the system, and that means we can help each other out.

[Andrew Bennett]:

So this is about building a sense of community to improve all of our population's health.


What is integrated care? The national perspective

Integrated care is about giving people the support they need, joined up across local councils, the NHS, and other partners. It removes traditional divisions between hospitals and family doctors, between physical and mental health, and between NHS and council services. In the past, these divisions have meant that too many people experienced disjointed care.

Integrated care systems (ICSs) are new partnerships between the organisations that meet health and care needs across an area, to coordinate services and to plan in a way that improves population health and reduces inequalities between different groups.

Read more about the national integrated care developments on the NHS England website (opens in a new window)

Key national documents:

Integrating care: Next steps to building strong and effective integrated care systems across England
Published: 26 November 2020
Details how systems and their constituent organisations will accelerate collaborative ways of working in future, considering the key components of an effective ICS and reflecting a range of local leaders’ experiences.

Integration and Innovation: Working together to improve health and social care for all
Published: 11 February 2021
The Government white paper 'Working together to improve health and social care for all' sets out legislative proposals for a Health and Care Bill; including establishing ICSs in law.

ICS Design Framework
Published: 16 June 2021
Provides the next level of detail to ICSs about how they will operate from April 2022 and the core expectations as part of ICS establishment. It describes the ‘core’ arrangements expected for each system and the ways in which NHS organisations will be able to flex their approach to collaboration.

The King's Fund - the Health and Care Bill: six key questions

In this article, The King's Fund explain what the changes proposed in the Health and Care Bill will mean in practice and what the new system will look like:

The Health and Care Bill - six key questions


 

Our vision and purpose

The partnership of organisations working across the Integrated Care System have agreed a clear purpose for our work together. This will happen in neighbourhoods, local places and across the whole of Lancashire and South Cumbria.


 

Delivering Integrated Care: Summary

We have produced a document to explain how we are moving towards delivering integrated care in Lancashire and South Cumbria. The summary covers where we are now and what the future will look like, how this will benefit our communities and what this means for staff working across the Lancashire and South Cumbria Health and Care Partnership.


 

Developing Integrated Care Partnerships in Lancashire and South Cumbria

Our partnerships will create a feeling of belonging to a place, where all partners are valued and respected, and mutual support is offered to all partners. This will be particularly significant in challenging times. It is important to acknowledge that residents are co-partners in the continued evolution of ICPs, and that social movements in communities can increase people’s ownership of their own health and wellbeing and mobilise communities to support each other.

The common purpose of an ICP is to enable collaboration that will address specific place-based challenges and deliver within each place the component parts of the Integrated Care System (ICS) strategy.


 

Our Clinical Strategy: Creating a Healthy Population

The core clinical strategy for Lancashire and South Cumbria outlines the direction we will take to develop our clinical services over the next ten years. The strategy outlines the six key areas of focus:

  • Health and wellbeing of our communities
  • Living well
  • Managing Illness
  • Urgent and Emergency Care
  • End of Life Care, including Frailty and Dementia
  • Workforce

The strategy looks at what actions we plan to take as a Health and Care Partnership to improve outcomes in each of these areas. This was developed through working with clinical leaders across Lancashire and South Cumbria to ensure it captures the ambitions of the whole system.


Here what our leaders say about integrated care

[Andrew Bennett]:

Integrated care is just a way of saying joined up care.

I think what we are trying to do as a group of organisations is make sure that people when they are going through the healthcare system, feel like their care is joined up.

We've had a system that was invented about 30 years ago, of commissioners and providers and we talked about them being split, separated from one another.

And I think one of the effects of that has been we have ended up doing things to people, to people in the population, rather than with them.

So I think my my ambition, my vision for integrated care is that we're actually doing what people wanted us to do.

We want to work better together to join up the care that they get.

There are lots of good examples of how we are already joining care up.

We are doing a lot in our local neighbourhoods where perhaps GPs are working with the local social care department, they might be working with the police or the Ambulance Trust.

And talking to people in those communities about how we can join up the care around them.

That's prompting some really amazing results in parts of Lancashire and South Cumbria.

Inside a hospital you might ask different professionals to work together to improve a pathway for someone when they need hospital treatment.

But the other element to this is thinking about the future, planning for the future.

We know that our population is getting older, for example, so people's needs in old age are perhaps different from how they were 20 or 30 years ago and we can do a lot more for people of course.

We also have some really clear pockets of deprivation in Lancashire and South Cumbria and we need to be taking some action over a number of years to really help people to address those and be healthier in the longer run.

The take-away message from me is that we should carry on being really ambitious.

I think people come to work wanting to do their best, they often talk about making a difference.

And actually in in most people's day-to-day lives they want to do that, they want to look after their patients or they want to support citizens in the community.

So this is about building a sense of community to improve all of our population's health.

[Dr Amanda Doyle]:

We have got this traditional model, a way in which we have always worked.

Which has very much relied upon diagnosing and treating and discharging patients and very hospital based.

But actually what we are seeing now is an increasing number of elderly people with long term conditions and the aim for these patients is often to keep them as well as possible and independent in their own homes for as long as possible.

If we continue to work in the way we've traditionally worked, we are never going to do that.

That will be an impossible ask.

The reason for that is that demand is continually outstripping our ability to deliver care.

We also have to recognise that unless we take a different approach to preventing ill-health and to enabling people to manage their own long term conditions we are never going to keep up with demand.

And one of the solutions to that problem is to integrate care, so that instead of all of our organisations working in isolation, we bring them together, we integrate things so that we deliver services more clinically effectively but also cost effectively.

And so this is about making people healthier, influencing the lifestyle factors that lead to ill-health.

Whether that's smoking, it's obesity, it's alcohol, it's substance misuse.

We have a high incidence of mental ill-health.

We need to develop resilient communities who understand their health, who know what to do to keep themselves healthy.

And who also know how to manage long term conditions, things like diabetes and asthma and chronic pulmonary disease once they've got them.

So we're developing networks of Primary Care practices and community services within neighbourhoods, working with community groups, the voluntary sector and the community in those places to really empower people to help look after themselves, help keep themselves well and to give people other options rather than just traditional health services when things go wrong.

[Mr Andy Curran]:

Within Lancashire and South Cumbria it's really important we have an integrated health and care and social care partnership.

We have some incredible challenges, when you look at us compared to other parts of England.

We need to make sure that every person who is born has the best possible chance of living a healthy, productive life, where they are happy with their wellbeing, where they have achieved what they want to be.

If we just focus on people who have disease and ill-health it's too late.

We need to help people prevent themselves from becoming unhealthy and becoming unwell.

It's enabling people to make their own choices, but feeling like it's worthwhile doing that.

Co-designing the services that we deliver is really important.

Knowing what is important to our population, what they value.

The people who are getting really good satisfaction from their lives and happiness with their lives are able to create their own wellbeing.

We need to make sure as society that we are enabling people to do that.

We've heard a lot of talk before, we've heard a lot of promises but now this is about relationships, this is about sitting down in a room with people and all of us being in this together.

It's not about competition between the organisations, it's about looking each other in the eye and saying: 'We are going to do our best'.

Which might mean that my organisation isn't bigger it doesn't have more money coming in, but actually, this is all about the patient and our public and making sure we do the right thing for them.

It's a really exciting time.

[Gary Raphael]:

We've all got a stake in the performance of all of our organisations that work round here.

If you are really successful as one organisation but your neighbour down the road perhaps is struggling there's a mechanism in place now which means that if we don't help them out, if we don't ensure that they are able to meet their objectives just as well as we are in this particular organisation, then we are all going to fail.

And I think what that will do, it will encourage a lot more partnership working between the organisations.

Not just in finance, but also in the way that we might share staff, the way we might organise the way that pathways work, how we share our expertise.

If we can get more efficient in those areas, we can release those resources to perhaps pick up the things we're not doing so well at the moment and maybe even do some things like get our waiting lists down, get our waiting times down.

We can start to use the money in that different way.

So the financial agenda for the NHS, and for the rest of our partners across Lancashire and South Cumbria is not just about savings, it's about how we utilise the money better than we are now.

And there are opportunities to do that.

I think the take-away message for the public and for our staff is that what we need to do in the health services and in public services is get the best deal for them in how we spend their money.

And if we do that as a system we've got more chance of being able to succeed than if we just leave it to individual organisations and that's what we are focused on.

[Talib Yaseen]:

We have an integrated care system in Lancashire and South Cumbria so that we can try to provide more coordinated and connected services for the patients that we serve.

Part of what we need to do is take all of the resources and say could we do things differently, could we provide more reliable, safer services but within the financial resources that we have.

So that's part of what we are trying to do.

Most of that isn't about the money, or the buildings, it's about a mindset.

What could we do differently, how do we learn from other people across England or elsewhere in the world that have got really well organised services but done in a different way to the way that we do that.

We need to balance up how do we do stuff locally, that meets local need and some of that is very place based.

It might be around six streets or a particular neighbourhood.

Some of it is saying no, the best way to do this is to put it in a specialist centre where you do lots of it, people are expert, and we can get you in and out quickly.

That's the real challenge that we have but to do that in an open and honest way.

Not everyone wants to be involved in that conversation but our job is to take that conversation to them and to at least try to inform them about what the possibilities are.

And there will be different world views and we have to accept there are different world views and not everyone will be supportive.

But we have to look at how do we make the best use of our staff and resources and how we organise care for the whole population, so ideally make the best use across the system but also make sure that that local service meets the needs of people

24 hours a day 7 days a week.

[Karen Partington]:

We are all facing the same problems around workforce.

There are too few people for too many jobs that we all have vacant at the moment.

That is the position across the country not just for Lancashire and South Cumbria.

So by working together it means that we can bring all of the ideas about the different roles that we might be able to use as substitute roles.

For example, we know that some of our medical vacancies are really difficult to fill so if we start to look at what are the skills required for those roles, can we use other people to actually fill some of those gaps.

So I think by coming together it helps us understand the pressures across the system but also to pool our ideas, our innovative solutions together so that we can move forward.

Working together is important because if we start to operate as silo organisations we will see the same workforce moving from one area to the next.

Actually what we want to do is to make this a really attractive place to work.

So we are bringing in people from outside of the region to work alongside our teams.


 

Making a difference: read our stories of joined up working in action

There are lots of examples of ways in which organisations across Lancashire and South Cumbria are working together to deliver better services and outcomes to the people living and working there. To highlight the benefits of joined up working, we have gathered some stories to show how we are already making a difference through partnership working.


 

Our draft integrated care strategy for Lancashire and South Cumbria

The NHS Long-Term Plan set the ambition that every part of the country should be an integrated care system by 2021. Lancashire and South Cumbria was one of the first 14 areas to be announced as working as an integrated care system in 2018. 

The partnership of organisations working across the Integrated Care System have agreed a clear purpose for our work together and a draft strategy has been developed with involvement from all partners which sets out as a system how we will deliver the aims of the NHS Long Term Plan and address the most urgent needs of our population.

The document was in draft form in early 2020, however it was never published as a full strategy due to the pressures of the Covid-19 pandemic response. 

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