Delivering Integrated Care: Summary
This document is written for people working in the Lancashire and South Cumbria health and care system and local people interested in these developments. It describes the way we are moving towards delivering more integrated care.
- Where are we now?
- Our purpose
- National context
- What will the future look like for us?
- Provider collaboratives
- The changes proposed: ICS
- The changes proposed: Place
- The changes proposed: Neighbourhood
- Joined up working in action
- What will this mean for staff?
- How will we measure success?
We have been working together for a number of years to join up health and care. There are many examples of how this joint working has made a big difference to the lives of local people; some are outlined here. The aim of the changes is to build on the work we have started – to further improve the health and wellbeing of the people living across Lancashire and South Cumbria and reduce health inequalities.
Our integrated care system (ICS)
Lancashire and South Cumbria Health and Care Partnership is the name of our ICS, which provides strategic leadership for health and care. It includes local authorities, the NHS, voluntary, community, faith and social enterprise (VCFSE) organisations, academic institutions, other public sector organisations and communities.
Why we need to change
Our challenges are significant and well documented. They are not unique to Lancashire and South Cumbria, although some problems are worse for us locally.
Widening inequalities, staffing, funding, waiting times and pressures from an ageing population are all growing issues. Some of these
issues have been exacerbated by the Covid-19 pandemic. We must be bold in our collective efforts to solve these problems with urgency.
When decisions are made jointly, we can demonstrate that outcomes are better. There are many examples of this which can be found here.
The partnership of organisations working across the Integrated Care System have agreed a clear purpose for our work together.
Our agreed vision, as described in our ICS strategy, is to empower and support healthy communities so that people have the best start in life and can live and age well.
We will do this by working together, as equal partners, to listen to the needs of our population, join up health and care services and address the challenges we face.
What our vision means for local people and their families
Better health and wellbeing
- Have longer, healthier lives.
- Be more active in managing their own health and wellbeing, maintaining their independence for longer.
- Be supported to keep well both physically and mentally, with mental health and physical health being equally important.
- Be central to decision making.
Better care for all
People will have:
- Consistent, high quality services across Lancashire and South Cumbria.
- Joined up services and support which are easier to navigate and access.
- Services and support responsive to local need.
- Equal access to the most effective support, with reduced waiting times.
In February 2021 the Government published a White Paper outlining how the NHS in England needs to change to enable health and care to work more closely together.
It has long been our aspiration to improve the way services work together and to be excellent partners to each other, but bureaucracy has sometimes got in the way. The reforms therefore support our local ambitions by removing some of the current legal rules that can get in the way of joined up working.
In summary, the White Paper outlines how:
- Change is needed to enable health and care systems to further build on innovation born from the pandemic.
- The NHS, local authorities and other partners will come together legally as part of integrated care systems (ICSs) to plan health and care services and focus on prevention.
- ICSs will become statutory, and will be accountable for the health and wellbeing outcomes of the population.
- The current functions of clinical commissioning groups (CCGs) will move into the ICS.
- Legislation that hinders collaboration and joint decision-making will be removed.
- A ‘duty to collaborate’ will apply to NHS organisations and local authorities. This will promote joint working across healthcare, public health and social care.
- A shared duty to have regard for the ‘triple aim’ of better health and wellbeing for everyone, better care for all people and sustainable use of NHS resources is proposed.
- NHS England’s main role will be to support improvements in health outcomes, the quality of care and the use of NHS resources.
The proposals are designed to be flexible, and will allow our health and care system to continue to evolve in a way which best suits us locally.
However, the White Paper does not address adult social care or public health reforms; proposals about these are expected later in the year.
We have already started to organise our work across different interconnected geographical footprints. The changes planned will build on this.
Place-based partnerships (ICPs):
Serving populations of up to 500,000, place-based partnerships bring together planners and providers across health, local authority and the wider community to improve health and wellbeing. A more detailed document explaining about place-based partnerships is here.
Reducing health inequalities
We will increasingly use data to improve health outcomes and reduce inequalities within all parts of the system. Better understanding the health of local populations to identify those who are at risk will help us to proactively plan and deliver care.
Local councils, and others, play a lead role in supporting healthy communities, through education, housing and environmental health, for example. Services which impact on the wider determinants of health will be engaged through the ICS partnership, the Health and Wellbeing Board and neighbourhood working.
Most people’s day-to-day care and support needs will be delivered in neighbourhoods of typically 30,000 to 50,000 people
Integrated care system (ICS)
Partnership providing strategic leadership for health and care across Lancashire and South Cumbria.
Providers of health, care and support services will increasingly collaborate at all levels of the system.
This is nothing new; there are some great examples of joined up provider working, especially during the Covid-19 pandemic. However, the current rules don’t always encourage provider collaboration.
The legislative proposals will change this. The duty to collaborate will apply to NHS and local authorities and will promote joint working across health and social care. In addition, the focus
of all NHS organisations will be aligned through the same ‘triple aim’ of:
- better health and wellbeing;
- better care; and
- sustainable use of NHS resources.
Different providers will collaborate at different levels of the system, according to need.
Some providers, such as those from the NHS, local authority, VCFSE and private sector, may work together within neighbourhoods to deliver community-focused services.
Other providers may work across the whole of Lancashire and South Cumbria to deliver specialised or complex services, or network acute care. The hospital and mental health trusts in Lancashire and South Cumbria have set up a formal provider collaborative board to drive this forward, ensuring we build on the joint working which supported the pandemic response.
NHS trusts, foundation trusts, local authorities and other organisations will still operate within a regulatory framework and have statutory duties. By working collectively, they will be more successful as individual organisations too, contributing to a more successful system.
A document with more detail about provider collaboration is being developed, and will be shared as soon as it is ready.
Benefits of provider collaboration:
- Improved safety, capacity, access and quality of care.
- Better workforce planning and skill sharing.
- Reduced variation in clinical practice and outcomes.
- Reduced health inequalities.
- Better use of clinical and corporate resources.
Lancashire and South Cumbria
- Brings together partners across Lancashire and South Cumbria to join up health and care services and improve population health, but no legal status.
- Joining up services can be difficult due to legal and organisational barriers.
- Consists of eight CCGs, NHS providers, local councils and multiple VCFSE organisations.
- Some services are commissioned once over a bigger footprint, but not all, e.g. hospital services are commissioned by each CCG for their areas.
In the future
- Becomes a legal body.
- Partners work as equals.
- Will be an enabler and problem solver across the Lancashire and South Cumbria system.
- Will receive government funding for Lancashire and South Cumbria health services.
- Health and local government will have a ‘duty to collaborate’.
- Will agree system health and care priorities and allocate funding to places.
- Will be accountable to NHSE for delivery of NHS system ambitions.
- Will do things that are best done ‘once’, e.g. commissioning hospital, ambulance and specialist mental health.
- CCGs will cease, with some of their commissioning functions moving to the ICS.
- NHS England will delegate or transfer the commissioning of primary care and certain specialised services to ICSs.
- Better outcomes: healthier population and reduced health inequalities.
- Higher quality, sustainable services.
- Financial stability.
- Individual organisations better supported by each other through cooperation and collaboration – improved performance of organisations and the system.
- Coordinated citizen and community engagement and co-production – better harnessing the experiences of people living in Lancashire and South Cumbria.
- Working over a larger area will increase efficiency and reduce duplication of effort.
Five place-based partnerships: Morecambe Bay, Central Lancashire, Fylde Coast, Pennine Lancashire, West Lancashire.
- Brings together partners across five places within Lancashire and South Cumbria, serving populations of 500,000.
- Partnerships are informal.
- Work to join up place-based services ongoing.
- Support to neighbourhood development.
- Some day-to-day services delivered here.
- Strengthened role to improve population health, reduce health inequalities and join up services.
- Greater focus on population health and tackling the wider determinants of health.
- Focus also on developing services to increase independence, support people at home for longer and avoid unnecessary hospital stays
- Supported by the wider ICS to achieve outcomes.
- Lead role for primary care and community services in planning and delivering joined up services.
- Will have delegated budgets from the ICS to plan local services.
- Increased joint decision-making and shared priorities.
- More joined up approach to workforce planning and recruitment.
- Arrangements made to ensure effective clinical leadership and engagement.
- Some current CCG functions delivered here.
- Decisions taken closer to the communities they affect are likely to lead to better outcomes.
- A greater focus on a proactive approach to prevention and wellbeing.
- Huge benefits for citizens of having integrated care in their neighbourhoods joining primary, community, social care and wellbeing services.
- Better workforce planning and skill sharing across all partners.
- Greater use of community assets.
41 primary care networks
- 41 neighbourhoods Lancashire and South Cumbria (typically 30,000-50,000 people in each).
- Each has a primary care network which brings together primary and community health and care providers with wider public service and VCFSE.
- Most day-to-day services delivered here.
In the future
- Most care will be delivered here.
- Neighbourhoods will increasingly influence place-based partnership priorities.
- Lead role for general practice and community services in planning and delivering joined up services.
- Further expanded social prescribing available in communities.
- Health and care services will be built around local communities, with services responsive to local need.
- All partners’ skills, knowledge and innovation harnessed.
To support this work, we will adopt a joint approach to citizen, community, workforce and provider engagement across all partners within Lancashire and South Cumbria.
Our priorities are to:
- Agree a joint approach to engagement to support the design, development and co-production of health, care and support services, with citizens as meaningful equal partners.
- Ensure robust lay and elected member oversight at all levels of the Lancashire and South Cumbria system. We must ensure the public’s voice drives decision making.
- Ensure clinical and other frontline leaders are able to lead work to create sustainable care models across all levels of the Lancashire and South Cumbria system.
We hear from local people through:
- Surveys and questionnaires
- Public engagement events
- Face-to-face interviews
- In-depth conversations
- Telephone interviews
- Community group discussions
- Involvement of patients with lived experience, taking active roles on boards and steering groups.
- Events with neighbourhoods
- Comment cards
- Outreach with specific groups.
There are many examples across Lancashire and South Cumbria showing the benefits of joined up working, including:
- Partners across the whole of Lancashire and South Cumbria, including the police, fire service and local businesses, came together to deliver the tremendous Covid-19 vaccination response. The significant community contribution saw thousands of volunteers and retired staff supporting the response to Covid-19 and vaccine rollout.
- Local authorities and the NHS improved hospital discharge across Lancashire and South Cumbria, particularly in early 2021 when hospital occupancy was at its highest.
- NHS and Local authorities worked together on an integrated home response and falls lifting service to help residents in Lancashire who have fallen at home to get up and ensure they are comfortable and not injured. This relieves pressure on the ambulance service and the response for the lifting service can be much quicker than a non-urgent ambulance call out.
- VCFSE organisations and local authorities set up community hubs in each district of Lancashire to support vulnerable groups during the pandemic.
- Councils and care homes created designated secure settings where Covid-positive patients could be safely discharged from hospital.
- NHS and voluntary, community, faith and social enterprise groups in Lancashire and South Cumbria worked together on the Orange Button scheme; a community scheme to help people struggling with their mental health. Those wearing the orange button have undergone extensive suicide prevention training so that they can provide comprehensive signposting to relevant services.
As we build on the good work that is taking place across Lancashire and South Cumbria, it is becoming more important for us to share
the stories of how our partnership working is having a positive impact on local people.
We will continue to develop our stories as we go along. If you have a good story to tell, please email us.
Our teams will be part of new ways of working that better meet the needs of local people.
- Working collaboratively will create new and flexible roles, with development opportunities for staff and increased job satisfaction.
- Health and care professionals will have more time to spend with people who need their help.
- Having a greater impact on the health and wellbeing of our communities and a reduced level of bureaucracy will create a happier workforce with greater levels of purpose and job satisfaction.
- Shared records and increased data sharing (another change outlined in the White Paper which will make joined up working easier) will allow more timely access to patient information.
- There will be improved communication between staff across all parts of the Lancashire and South Cumbria system.
- New technology and improved communication between services will make working lives easier and more efficient.
Our ambition is for all partners to be recognised for their contribution. This includes VCFSE organisations being commissioned effectively for their services and for social care staff to be fully recognised for their value in providing care and support to vulnerable people.
Clinical commissioning groups
We expect that CCGs will cease to operate from 31 March 2022. The functions which have traditionally been undertaken by commissioners are being reviewed and will move to other parts of the system.
We place a huge importance on retaining talent, skills and capabilities in Lancashire and South Cumbria. We are pleased that NHS England has made a commitment of continued employment for those affected by organisational change. We will be working in partnership with staff side representatives throughout the developments, and will ensure that arrangements for support are in place. We are awaiting national HR guidance, and more information will be available when we understand what this means locally.
We are working to define some specific measures, and are keen that they focus on outcomes, wellness and the wider determinants of health. As part of this process we will be asking our communities what success will feel like so we can measure what is important to them.
Next steps – locally and nationally
The Bill is set to be brought forward in the next parliamentary session, most likely in early summer. Since April 2021, all areas of England have been covered by ICSs, with a view to them being statutory bodies by April 2022.
We will make sure colleagues, partners and members of the public are informed about any developments as early as possible.
We thank all of you – you are working so incredibly hard and doing an amazing job. We will continue to build on this while these legislative changes are implemented.