NHS Reset: ICSs need to be powered up in the resetting of health and care services |Cllr Tim Swift

Tim Swift

 NHS Reset is a new NHS Confederation campaign to contribute to the public debate on what the health and care system should look like in the aftermath of the COVID-19 pandemic.

In this blog, part of a series of comment pieces from NHS Confederation members and partners, Cllr Tim Swift writes on how relationships and partnership working continues to be paramount, underlining that it is the foundation from which we start.

As we look beyond the first phase of our response to COVID-19, there is an opportunity to stabilise and reset how health and care is planned and delivered as set out in our five year plan, in line with the ambitions for the 2.7million people who live across the area.

Earlier this month I joined other leaders of integrated care systems (ICSs) and sustainability and transformation partnerships (STPs) for a discussion around the role of ICSs. As you would expect there were various views – and as you read the ICS Network report Time to be Radical? you will see an overall view that the time is now right for new system powers.

The report acknowledges that the polling questions it was based on do not allow for a lot of nuance, and conversations must continue with a wider range of stakeholders. I am broadly in favour of more statutory powers for ICSs developed within a framework of accountability, particularly if they are to become the future planning function of the NHS.

My preference is towards an incremental change approach, coordinated with the support of our local partners, with ICSs given clarity on legal powers and in particular empowerment of joint committees such as in our case the Partnership Board which can cross the health/local government divide.

This needs to be accompanied by a shift in resource towards self-improvement and meaningful peer assessment, and clarity on mechanisms for pooled budgets. It would also be helpful to see a commitment that any additional money is channelled through partnerships with a resolution to the social care challenge which needs a long-term plan parallel to that provided for the NHS.

More powers for ICSs is only part of the answer. Experience tells me that, even with some additional powers for systems, much will depend upon the development of trust and reciprocity across the partners. Pooled budgets, for example, aren’t the full picture – trust and strong partnerships make the real positive difference.

Genuine partnership working – with a very clear model of subsidiarity and place-based partnerships – and effective relationships between ICSs and local councils can really drive plans to deliver for populations. That is what we are developing in West Yorkshire and Harrogate, built on over four years of working together.

What we’re doing across the region

In our system, the leadership and colleagues, in their role as part of Health and Wellbeing Boards, have plans to deliver ambitious improvements to health and social care services for people in Bradford, Airedale, Wharfedale, Craven, Calderdale, Harrogate, Kirklees, Leeds and Wakefield.

These plans, alongside our West Yorkshire and Harrogate priorities and big ambitions, allow us to work together on the challenges we collectively face to make a fairer society for all across the area. The sharing and scaling up of good practice also helps.

In 2018, we established our Partnership Board to strengthen joint working between all organisations involved and most importantly to further improve health and care for the people living across the area. Working alongside communities, the board brings together the NHS, councils, care providers, Healthwatch, and community and voluntary organisations to give people the best start in life with support to stay healthy and live longer. An important part of the work is tackling health inequalities while improving the lives of the poorest, the fastest. COVID-19, with its disproportionate impact on those with the greatest challenges and on black and minority communities, gives added urgency to this work.

Learning from local government

There is, I think, something to be learnt from the creation of combined authorities in this, They have their own independent legal existence, but their success and effectiveness depends upon active participation of all local authority partners. The more engaged the partners, the more that will be delivered. That is why our partnership approach in West Yorkshire and Harrogate is founded on a strong principle of subsidiarity, with decisions only taken at a partnership rather than a more local level when it meets one of our clear principles for collective action.  In designing any new system, we need to think carefully about how to work with local government as equal partners around the table. The NHS is a very top-down command and control structure, and we don’t want to bring local government into that culture. We have worked hard across West Yorkshire and Harrogate to achieve this and to get the balance right.

Another option for the future is to introduce greater opportunities for self-improvement and peer review. These approaches are well developed in local government and can bring many benefits to all partners involved. Using such approaches alongside a smaller regulator function could give greater ownership of improvements to the systems delivering the change.

COVID-19 has provided an appetite for a reset. To enable us to improve care for those we collectively serve then ICSs would benefit from stronger foundations and wider powers, but ultimately it will be working with a wide range of partners, not least the umbilical link with local government, which remains the priority.

Cllr Tim Swift is leader of Calderdale Council and chair of West Yorkshire and Harrogate Health and Care Partnership (also known as integrated care system). Follow them on Twitter @TimSwift, @Calderdale, WYHpartnership

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