Integrated care
The challenges ahead for delivering integrated care
Kate Woodhead RGN DMS considers the challenges around delivering ‘better integrated care’ and explains the frameworks and strategies that seek to focus on prevention, better outcomes and reducing health inequalities.
Serious effects from the pandemic still affect the NHS, and may be felt for a few years to come, hospitals and staff are under extreme strain, the backlog of unmet needs is growing and there is a major reorganisation being undertaken. It is no wonder that the effect is clear for everyone to see. NHS England is driving the changes towards
better integrated care, as it fervently believes that joined up care serves people better than the current fragmentation. Local partners which include the NHS, councils, the voluntary sector and others, when working together, are capable of creating better services, based on local need. In July 2022, the framework of Integrated Care systems (ICSs) was set up to make this work. Their key aim is to improve health and care services focusing on prevention, better outcomes and reducing health inequalities. They have arrived in the middle of a cost-of-living crisis, which is affecting the poorest people in the country – those who perhaps are the key people who the ICSs are aiming at. Aside from the challenges which the NHS alone faces, there is enormous budgetary stress in many of the local authorities who are having to make substantial cuts to services. The cost-of-living crisis is having a profound impact on people’s mental and physical health, exacerbating their health needs and increasing demand for services. Many of the food banks which have been set up over the last few years are now having their grants cut,1
so that the
social infrastructure and food parcels look in extreme danger of having to be stopped unless other sources of income can be found. This would only increase the vulnerability of a very vulnerable population.
How do Integrated Care Systems look? The ICS is essentially a collaboration between the NHS, commissioners and local authorities in 42 different areas, covering populations of between one and three million people. ICSs will become the new intermediate tier of the health
system and control a budget on behalf of the NHS and others. So, what are their main aims? These teams,
now working together, are designed to: l Improve outcomes in population health and healthcare.
l Tackle inequalities in outcomes, experience and access.
l Enhance productivity and value for money. l Help the NHS support broader social and economic development.
These are major long-term goals and, while very admirable, it is difficult to see how the business of delivering healthcare can be swerved away to manage such huge strategic goals as tackling inequality as proposed. There is international research2
which supports the premise that
a healthy population is more economically active and productive, and they are no doubt noble objectives. But it is difficult to imagine how the NHS and local councils, under their present cosh, can not only develop new working relationships to begin to tease out the issues they have to tackle but also, under the present strain, turn their heads to a brand-new focus for their services.
Specifically, the healthcare service across the
board have been tasked with additional duties to: l Streamline access to care and advice to meet the needs of infrequent users of healthcare services.
l Provide more proactive, personalised and multi-disciplinary care for people with more complex needs.
l Help people to stay well for longer, through a joined-up approach to prevention.
ICSs are going to be able to make their own decisions on how the different partners work together in each area. Much of this will depend on factors like geography, size of population, how many different health and care organisations there are, and how they have worked together in the past. Working together, the ICSs have formed ‘partnerships’, which are to deliver improving local health, care and well-being, and become Integrated Care Partnerships (ICPs). Out of interest, this author turned to her local
area ICP, the West Yorkshire Health and Care Partnership, to see what they have been doing and how they are progressing. They report that they have been working together for much longer than the statutory indicator of July 2022.
April 2024 I
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