INTEGRATED CAR E SYS TEMS
communities this has been.
One criticism is that leaders and clinical leaders are engaged in the process of development of new ways of working but it is less clear whether clinical staff are also involved. During the pandemic their focus, of necessity, has been elsewhere. However, a bonus from COVID-19 has been a deeper understanding of the challenges which affect the social care and community- based services in London. Barriers which usually are in place such as different funding arrangements and information governance were temporarily suspended during the pandemic which helped an acceleration of collaboration between different parties. It remains to be seen whether the benefits of the collaboration will remain in the longer term.
Key challenges for London ICSs The key priorities for London ICSs to tackle which were identified in the recent King’s Fund report, are health inequalities, digital technologies, workforce, estates and social care. Added to these in the light of the pandemic is the enormous backlog of planned care and the deterioration in health of many of them. In addition, the NHS is delivering an unheralded vaccination programme and London has demonstrated some considerable hesitancy among some communities. Health inequalities have come to the fore during the pandemic due to the apparent vulnerabilities of some ethnicities. ICS Plans to tackle health inequalities reveal commonalities across London which are that the approaches to reducing inequality should be data-led, to build relationships with voluntary and community organisations to extend the reach of services and to provide targeted support for specific vulnerable groups such as the homeless, people with learning disabilities and others. An example of ICSs partners working
together to benefit patients was that if there was a degree of asthma in the area, then investigation should be made into damp housing and means to improve air quality. Digital technologies have been on the
London agenda for some time but now are designed to assist with population health modelling across all areas of healthcare. There are tools which help to identify people who may benefit from proactive multidisciplinary support and make investment and prioritisation decisions. Chronic disease support will be provided by the use of digital self care and self – management tools. The use of telemedicine and telecare will be increased specifically with care homes. And there are many other ambitions to implement but the report cites that the pandemic has accelerated many of the commitments. Primary care is using video and telephone conversations widely and there is no reason to suggest that this will stop in future. Workforce is the Achilles heel across all future plans, and is a general weakness as so many healthcare staff in primary care particularly are reaching retirement age. High staff turnover rates in acute and social care are also of great concern.
There are many actions planned to reduce turnover but, in the view of this author, the consequences of the pandemic on staff morale and mental health have yet to be visualised, and may lead to many staff leaving their roles exacerbating the issue. NHS estate – its building, land, equipment and other physical assets – is said to be a critical issue in London which can act as both a facilitator of improvement and a barrier to it. Objectives of working together at system level on estates include the following: l Agreeing a shared set of priorities for targeted investment.
l Ensuring buildings are used efficiently and that under-utilisation is minimised.
l Supporting new models of primary and community care by establishing community hubs for multidisciplinary working.
l Co-ordinating estate rationalisation to generate income to reinvest in local estate.
l Expanding estate capacity to meet growing demand for planned care.
Social care is the final priority for the ICSs, and the light has certainly been shone upon many of them during the last year. However, on the plus side, there has also been a greater understanding of the challenges. There is currently great pressure on local authority budgets, having been squeezed for a number of years. The Government has promised to come forward with its long overdue plan for social care later in the year. Meanwhile, the ICSs are in difficulty with making any long term plans in the absence of national action.
Conclusion
The ICS movement is most definitely the philosophy most healthcare workers would like to have as an environment in which to work and not the silos of the recent past with competition as a basis for relationships. This has not been natural and certainly not in the best interests of the patient. However, the development of the integrated care systems is not without its difficulties. There are often financial, political and priority differences and it will take some effort to make the relationships work.
Among all the other current challenges regularly reported in this journal, the goal is wonderful but the climb to achievement is great.
References 1 NHS England. Definition of Integrated care systems. Undated.
https://www.england.nhs.uk/ intergatedcare/what-is-integrated-care/
2 NHS England & NHS Improvement 2020 Integrating care: next steps to building strong and effective integrated care systems across England. Accessed at
www.england.nhs.uk/integratedcare/integrated-care- systems/
3 NHS England & NHS Improvement 2019 NHS Long term plan
www.longtermplan.nhs.uk/publication/ implementationframework.
4 The Kings Fund 2021 Integrated Care Systems in London. Challenges and opportunities ahead. https://
www.kingsfund.org.uk/publications/integrated-care- systems-london
5 Ibid 6 Health inequalities strategy. 2017 Accessed at
https://www.london.gov.uk/what-we-do/health/ london-health-inequalities-strategy
7 Ham C, Alderwick H,Edwards N, Gainsbury S 2017 Sustainability and transformations plans in London: an independent analysis of the October 2016 STPs.
www.kingsfund.org.uk/publications/sustainability- and-transformation-planslondon
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