Jon Rallings, Senior Policy Advisor for Adult Social Care, County Councils Network
As 2022 becomes 2023, the newly created Integrated Care Systems (ICS) which came into existence last summer are set to become a more normalised part of the health and social care landscape.
These bodies replaced Clinical Commissioning Groups and were a welcome recognition from the government that health and social care are two sides of the same coin and that closer integration between the two will help solve challenges in both parts of the health system.
Designed to create a step change in integration and to try and ensure a more preventative local health system is created, the formation of ICSs were treated with optimism from the County Councils Network’s (CCN) member councils. They recognised this as chance to build closer relationships with NHS partners and drive integration and transformation to a much greater extent than their precursors.
But with all restructures, the litmus test is how well they work in practice. To assess these burgeoning relationships, the CCN commissioned a report from IMPOWER which was published late last year and offered the first stock-take on ICSs from a local government perspective. The report reflects extensive surveys and interviews with local authorities in as well as consultations with NHS colleagues.
As alluded to above, most interviewees from both sectors showed clear enthusiasm for ICSs. Four-fifths of councils said that they had increased their time working with health partners since the summer and have said that they have invested significant time into their ICS.
But there is a danger that this optimism soon evaporates. The survey found that there is a mixed picture on how well ICSs have worked and performed in the first few months.
This is perhaps unsurprising when considering how few ICS boundaries align with those of local authorities. Just four councils share coterminous boundaries, with some counties spread across as many as three ICSs, tripling the bureaucracy and making a consistent county-wide offer almost impossible. Whilst some authorities are developing positive place-based arrangements to overcome these, or share seamless boundaries, others feel mired in this bureaucracy.
In addition, with only 9 of the 91 local government appointees to Integrated Care Boards (ICB) being elected councillors, there is not necessarily the right balance in decision making, with the local government respondents in the report suggesting there is still too much of a focus on immediate NHS pressures rather than a longer-term focus on integration and prevention.
This is crucial. For the potential of ICSs to be maximised social care needs to be recognised as a valuable service in its own right and not just in how it supports the NHS. Simply, ICSs need to think strategically in the long-term about how a well-functioning social care system will take pressure off the NHS through prevention, rather than only addressing short-term issues like hospital discharges.
We have a window in time where some small steps can help change the perception of ICSs from local government and to enable relationships to take root.
The government has already commissioned a review of ICSs, led by Patricia Hewitt. We were pleased that CCN’s chairman Cllr Tim Oliver (who is also chair of Surrey Heartlands Integrated Care Partnership) was invited onto the review team and we will await her findings in March, but many in local government will be buoyed by her recent comments which suggested there was still too much ‘top down’ working within ICSs.
I encourage colleagues within the health service to take a look at the report – there is a vast amount of knowledge from both NHS and local government that can be fused together to create better health outcomes – with social care getting the focus it needs in ICSs and ultimately reducing pressure on health service in the long run.
