Joint working across health and care should be embedded in law and encouraged through a new statutory duty for all providers, commissioners and other partners inlocal systems.
With the Government expected to introduce new primary legislation affecting the NHS over the coming year, NHS leaders have set out the factors they believe should be central to a new framework for integrated care systems (ICSs). They believe Covid-19 has demonstrated the importance of organisations from across the NHS, local government and community and voluntary organisations working collaboratively for the good of their local communities.
The NHS Confederation’s six-month engagement process across its membership in England has revealed broad support for giving ICSs statutory footing in law. This must permanently embed system working across the wide range of organisations involved in health and care andrecognise the key role that local government, independent and charitable providers, voluntary sector organisations and community representatives play in systems alongside NHS services.
The NHS leadersspoken to largely agreed withwhat the purpose of an ICS should be, namely:
- to deliver improvement in the health outcomes of their populations;
- to reduce health inequalities;
- to integrateprimary, community and secondary services, physical and mental health services and health with care;
- to improve the quality of health and care services and the reduction of unwarranted variation; and
- to ensure efficiency and efficacy in how funds and resources are allocated.
The NHS leaders told the NHS Confederation that giving ICSs statutory footing must be subject to certain conditions. For example, the process of moving to a statutory system must not be rushed, so ICSs should operate in shadow form for a significant period of time to allow for careful planning and the ironing out of any local issues.
The report calls for:
- Embedding partnership working across the range of organisations involved in health and care: Whatever form integrated care systems adopt through statute, they must embed partnership working across the wide range of organisations involved in health and care. There is consensus across the NHS Confederation membership, and among partners in local government, that systems must not simply be delivery arms of the NHS. They have evolved, and must continue to develop, as partnerships of organisations working to deliver improved health and wellbeing in their local communities.
- A shared duty on NHS organisations to build on partnership working where it will benefit their patients: Eight out of ten NHS leaders responding to an NHS Confederation survey support the creation of a shared statutory duty on NHS trusts, Foundation Trusts, CCGs, local authorities and other system partnersto buildon existing partnership working, develop a sense of shared accountability for improving population-level outcomes and incentivise joint-commissioning.
- Radical reform of NHS oversight models: While nationally driven priorities and standards for the NHS are important, members were keen for oversight of their work to be more outcome-focused in future and driven by their local needs and solutions. The pandemic has shown that a reduced regulatory burden is conducive to rapid innovation and so a lighter leaner oversight model should be built into the NHS to embed this permanently.
Danny Mortimer, chief executive of the NHS Confederation, said:
“For too long, the NHS and other public services have had to work within a legislative framework that has encouraged the fragmentation of services and not recognised the importance of collaboration. What members point to in recent years are hugely positive local collaborations which better respond to the health and wellbeing needs of local communities.
“The pandemic has accelerated this direction of travel withrapid change and improvement, as organisations from across the whole of the NHS as well as local government, community and voluntary organisations,working truly collaboratively for the good of their local communities.This has resulted in lean, agile and responsive health and care, and we must seek to embed this for the long term.
“Legislation alone is never the answer to resolving issues within health and care. More important are culture and relationships as well as better long term national policy. However, the Government has an opportunity with new legislation over the coming year to fix many of the problems inherent in the existing framework that so many now findcounter-intuitive. Now is the time to develop a framework, built on the experience and expertise of NHS leaders, that facilitates and incentivises collaborative working across health and care.”