The ICS arrives on the 1st of July 2022

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The Integrated Care System arrives in Northamptonshire and elsewhere on the 1st of July 2022.

NAVCA (The National Association for Voluntary and Community Associations) has been working with Lev Pedro Consultants to distil information about the ICS and what this might mean in the future for both individuals and the VCSE sector. Their latest guidance is provided below:

Shall we start with a jargon check… Do we know our ICBs from ICPs and ICSs? 

  • Integrated care system (ICS) is the new arrangement that will underpin the planning and delivery of health and social care. The ICS brings together partners from across the NHS, local government and independent (voluntary and private)  sectors. The ICS is about all of us, not just the NHS!
  • There will be a new NHS integrated care board (ICB) a statutory organisation operating across the system area which will replace clinical commissioning groups (CCGs). This will have a core team at system level and work at place level (together with local stakeholders including districts and borough councils, the VCSE sector and NHS providers).
  • The integrated care partnership (ICP) is a statutory committee that connects all stakeholders in the ICS as equal partners. This is jointly convened by both the NHS ICB and the upper tier local authorities and will involve a wide range of stakeholders. It will set the strategy for the ICS and needs to work in a way that is aligned to local health and wellbeing boards.

What’s Changing in July?

Service providers should not worry that suddenly all their commissioned contracts will be aggregated to system level, and all their local relationships will be lost. This is not the case. There is a big emphasis on ‘place’ in the ICS design guidance. One of the main bits of advice that we’re hearing is that the first year at least will be transitional. For some services, there may indeed be moves to build clinical pathways across the system area, over time, but most day-to-day commissioning will continue at place level for the time being. Transitional arrangements for at least a year will give everyone permission to acknowledge and fix when something isn’t working.

And what do we all need to do to embrace the change? What behaviours are needed to make this a truly equitable partnership between NHS and the VCSE?

Suffolk and Northeast Essex was one of the first systems in the country to become an ICS. At its heart, it is an equal partnership across the NHS, local government and voluntary, community and social enterprise (VCSE) sector, increasingly characterised by:

  • Positive relationships between local health and care leaders
  • Courageous joint action to address problems, and
  • A genuine ‘Can Do’ attitude that enables meaningful partnership and integrated thinking and working at every level.

At its heart lie 7 principles:

Equal means equal:

The NHS England guidance talks a lot about equal relationships. But saying it is easy. How will this be achieved in reality? What are the systemic barriers to achieving this? How can we remove those? It’s not just about seats at tables – it’s real sharing of power. Equal really means:

  • Equal voice and representation
  • Equal influence
  • Equal opportunity
  • Equal access to information
  • Equal support
  • Equal investment
  • Equal expectations.

Tear up the rule book:

Integrated care is a new way of working for the NHS. ICSs are intended to be true partnerships of the NHS, local government, communities and the VCSE sector, focusing on local issues, local needs, and local determinants of health.

“They’re not like anything that’s gone before – they’re a novel construct in a novel world where things are really changing. 

“Take away all of your perspectives, all of the patterns’ people will want to put on to things so we understand them. This isn’t the way this is going to work.” 

Rob Webster, West Yorkshire Health and Care Partnership, May 2022 

True, the NHS has been focused on the new structure lately, but to think that integrated care is just about NHS staff having a new name badge is completely missing the point. Integrated care is about system thinking and working and bringing all stakeholders together in a less competitive and more collaborative way of working.

Relationships matter:

The basis of good partnerships is relationships, and this is even more the case when moving a to a more system based and less transactional model. This is about people FEELING like they are part of a team with shared values, mission and goals, and the tools to make that teamwork translate into successful work. Relationships need investment and nurturing.

Walk the talk:

Who sets the narrative in an ICS? What opportunities are there for VCSE sector leaders not just to listen in to conversations led by the NHS or local government? VCSE sector leaders must be able to bring their issues to the table.

Equal relationships also require ‘adult to adult’ transactions which are open, honest and direct. Working these out together as a partnership is an important aspect of building sustainable relationships. In brief:

  • Keep it simple
  • Respect my time
  • Match my effort
  • Keep your word
  • Always be honest
  • Stay consistent.

Lead and cede:

It’s important to start with the ‘why’, then go on to the ‘how’, and only then the ‘what’. When time is short it’s far too tempting to start with the ‘what’ – in other words a plan or a strategy, before working out why we’re in the room, and what the problem is that we are seeking to fix. Then who should be in that conversation?

Strength lies in diversity:

The VCSE is complex, it’s messy, it’s poorly coordinated. But this is for very good reason. VCSE organisations have grown to meet a need in the community, or to campaign on an issue, or to prevent a tragedy from recurring, or whatever. There’s no master plan. That diversity is what makes it great, makes it agile, and responsive, as we saw during the Covid pandemic. The task is for that diversity to be celebrated and harnessed. The VCSE sector has been challenged to make this happen by forming VCSE alliances, and these are at varying levels of maturity across England. One of the biggest challenges these alliances face is representing the full diversity of community interests and health and care needs. Local infrastructure organisations could be the conduit for this to happen.

The future is in our hands: 

With integrated care there really is an opportunity for us all to do things differently, not for the sake of it, but because it has the potential to really deliver better for our communities. Covid gave us the chance to remove barriers and get things done. Now let’s build on that, let’s “feel the fear and do it anyway”. Let’s be the change.

Notes:

In West Northamptonshire 9 Local Area Partnerships are being formed around the concept of Place. In North Northamptonshire there will be 8. The VCSE now has an opportunity to sit at these tables, but only where the Health Data and the Priorities dictate. Some VCSE organisations are coming to our Network Event on the 30th of June 2022, which is now booked to capacity. If as a VCSE organisation you are not booked to come but want to say something about what you hear or read, then contact VIN at info@voluntaryimpact.org.uk and put ICS in the header line. We will be collating responses from the VCSE (along with our partner Infrastructure Organisations) and placing these before both Directors of Place in the West and the North. Responses should be received by 31st July 2022.