TECHNOLOGY Under proposed plans to
reform local government in England, each new council will have a minimum population of 500,000,
creating the potential for future structural alignment with ICSs.
as a collegiate system, and as individuals and teams. Some choices will be hard and come with compromises and consequences. Having set our sights on a strategic goal, system partners need conviction from the top, and a leadership team that is clear and committed to its role, decisions, and the actions needed to achieve it. It is hard to collaborate across
traditional organisational and professional boundaries and share previously sovereign resources such as staff and excess capacity – but it is also hard to miss ICS savings or performance targets. It is hard to make an executive decision to close
Karen Bryson
With over 20 years’ experience in health performance improvement, strategy development, and innovation, Karen Bryson, Transformation Expert adviser at Lexica, has successfully led transformations in the health, local government, and public health sectors. With a transformation leadership career in the NHS, she joined PWC’s fledgling health advisory team, and was pivotal in pioneering corporate restructuring in the NHS. Later, as a director at KPMG, EY, and xantura, her most notable innovations include Pathway Integration – the NHS merger pathfinder to secure viable inner-city services in northeast London, and data integration and risk analysis to inform service design and commissioning. Addressing inequalities as Deputy director of Public Health in Staffordshire, Karen introduced place- based commissioning and joint ventures with the energy industry, tapping satellite technology to support vulnerable households. She was also a core member of the international team awarded the framework for health system reform in Sudan.
capacity needs by 50%, reshapes the workforce profile from acute-based nursing to community-based reablement therapy, and deploys technology to track clinical signs, advise, and support independence. This approach has informed the national service
framework for MSK (musculoskeletal) conditions, and shifted mental health services from acute to community settings. To illustrate the scale of impact possible, a redesigned pathway for frail elderly care identified £10 m in savings6
for one health and care system – extrapolating
this, the potential savings could be £420 m across England’s ICSs.
Orchestrate change across system partners The process of redefining the problem in the context of each place, and designing the ideal pathways to address local needs, requires system collaboration. Delivering the changes in a coordinated fashion across multiple system partners is also a collective responsibility, though likely to be more challenging. There will be a need to adjust or dismantle professional
and organisational boundaries, build new partnerships, merge teams, share resources, and replace, streamline, or relocate, with technology and reconfigured estates. It is also worth stating that form follows function, and future service configurations are likely to need a re-think of existing estates and NHP plans. A collegiate agreement on what the future sustainable model looks like, along with a collective understanding of interdependencies, boundaries and redlines, responsibilities, and accountabilities to the whole, are essential success factors. Inclusivity and frontline stakeholder ownership of the design, as well as the celebration of delivery milestones, will strengthen new collaborations, build confidence and trust, foster openness and learning, accelerate transformation, and make hurdles easier to navigate. Of course, well-structured programme planning, management, and governance accountable to the Board are essential. System delivery teams will need transparency and clarity on critical milestones, and when and how organisational and clinical roles, operating models, and target performance, will change over time, as illustrated in Figure 2. Strategic commissioning will need orchestration to fund services, pump-prime change, and incentivise performance. Transformation on this scale and reach is unfamiliar territory for the NHS. A transformation maturity framework that tracks and assesses roles, behaviours, and capabilities, against performance and transformation milestones, will provide ICS partners with insights into their development needs
74 Health Estate Journal March 2025
beds when ED is full, and new Urgent Treatment Centres and remote monitoring systems are having teething problems – but it is also hard to justify maintaining acute capacity for 40% of avoidable ED attendances. Hard choices, being bold, and having the mettle of a clear strategic rationale, are part of successful transformation.
Addressing health inequalities It’s not just about the system; however, it’s about health inequalities. How do we reduce the overall burden of poor health? This burden is personal, and is influenced by a range of determinants that Professor Sir Michael Marmot discusses in several reports7
and lectures.8
The impact of housing, education, food, air quality, community, and secure well-paid jobs on health inequalities, poor health, and life opportunities for new generations, is well known. These determinants are within the control of local government, policy, industry, and society. Once the local government reform and ICB reforms are in place, with a mayoral focus on place and industry, the opportunity to tackle these determinants should also come under the remit of a mature and evolving integrated care system – though its name may change by then. But the same principle remains – as the vortex tightens, keep changing the question towards what the system must do to reduce health inequalities.
References 1 Dunn P, Fraser F, Williamson S, Alderwick H. Integrated Care Systems; what do they look like? The Health Foundation, online. 15 June 2022.
2 Lister L. ICBs tight-lipped on deficits and consequences. The Lowdown, online. Centre for Equitable Healthcare. 10 May 2024.
3 Hu K. These smart technologies are transforming healthcare. World Economic Forum online. 12 October 2021
4 Santhanam V. How drones could change the future of healthcare delivery. World Economic Forum online. 8 May 2020.
5 ICBs aim for £8 billion savings, risking NHS staff and delays. The Lowdown, online. Centre for Equitable Healthcare. 23 November 2024.
6 Elderly Frail Pathway Redesign, Staffordshire CC and NHS, led by Public Health, 2019.
https://tinyurl.com/2ccywhra
7 Marmot M, Goldblatt P, Allen J et al. Fair Society, Healthy Lives (The Marmot Review). Institute of Health Equity, online. February 2010.
https://tinyurl.com/ysfx4b2k
8 Kempen M. Health inequalities, children and young people – Professor Sir Michael Marmot. The Association for Child and Adolescent Mental Health. 20 June 2023. https://tinyurl. com/4hsubza2
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76
