The architecture of the health and social care system hasn't fundamentally changed since 1948. It still isn't as joined up as it could be, so when people try to move around bits of the system there are barriers.
If primary, secondary, community, mental health, social care, local government and the voluntary, community and social enterprise sector are joined up, as an Integrated Care System (ICS), we will see patients moving through the system with a much smoother journey.
For example, cancer patients may go for screening or be picked up by primary care, and then move through secondary to tertiary care. They may use voluntary sector services such as hospices and need support beyond treatment, such as social prescribing or social care. ICSs should provide seamless movement between these services.
As ICSs we need to focus on preventing ill health and tackling health inequalities.
Currently we are a reactive service; we're good at treating ill health, but we're not as good at keeping people well. ICSs offer an opportunity to change that.
There is a lot of illness we could prevent if we did things a different way, such as developing strategies to decrease smoking, manage weight and encourage cleaner air. We can also concentrate on the wider determinates of health, such as housing, education and employment.
There is a national commitment to tackling inequalities in our most deprived populations with a focus on early diagnosis and improved care in five key areas: respiratory and cardiovascular disease, maternity, early cancer diagnosis and improving physical health for people with mental health problems. Integrating health and social care gives us a real opportunity to tackle these inequalities.
There are also benefits to doing things differently with our workforce. In South Yorkshire and Bassetlaw, we have a very active 'Workforce Hub'. This is partly about recruiting and retaining, but we are also looking at how we can use our staff in a different way.
Clinical and care professionals have a vast and diverse range of skills that we don’t always use in the most effective way. ICSs provide the opportunity to develop integrated workforce strategies and establish truly multidisciplinary teams, that make best use of all our colleagues’ talents and expertise.
We can develop strategies to share workforce. This might mean putting different types of workers into primary care, such as pharmacists, paramedics, social prescribers or first contact practitioners.
We can share staff between practices, within a Primary Care Network (PCN), or even between primary and secondary care. Paramedics might sometimes be in an ambulance and sometimes support work in primary care. By integrating primary care at place-level, a person might have their blood pressure checked in a pharmacy.
Colleagues from Workforce Hub visit schools to promote opportunities in health and social care. We do that as a system which wouldn't have happened if we were not working collaboratively.
So, what are the challenges of working as an ICS? Relationship building will be a key challenge. Each provider will still be an independent provider, even after legislative change, but nevertheless you need to be committed to working together.
Clinical and care professional leadership will be of the utmost importance. Legislation can change structures and processes but if we don’t have strong, resilient, multi-professional leadership across health and care, we will not realise the potential of ICSs. We must nurture the relationships and culture needed for ongoing improvement and cross-system working.
The pandemic has presented real challenges but also opportunities. We've rolled out technology at a speed never done before in the health system. We've got video conferencing for primary care patients and set up home reporting stations to allow radiologists to report from home – something we would never have done that if it wasn't for collaboration during the pandemic. We shouldn't retreat to our old habits but use this experience as building blocks to make integrated care a reality.
If we can get the relationships right and have providers, commissioners and regulators in the same room as we re-design services as well as bringing down the financial barriers to working together, we have a good chance of really delivering on the potential of ICSs.
We can really turn the dial to what matters. We've also got to hold our nerve because a lot of the time, the NHS in particular, is asked to meet short-term targets. What we are looking for is long term gain. We have to do the right thing, and eventually the outcomes will be evident.
