Integrated care They have stated ten big ambitions3 which are:
1. We will increase the years of life that people live in good health in West Yorkshire.
2. We will increase our early diagnosis rates for cancer.
3. We will reduce suicide rates. 4. We will reduce antimicrobial resistant infections.
5. We will reduce stillbirths, neonatal deaths, brain injuries and maternal mortality.
6. We will reduce the gap in life expectancy between people with mental health conditions, learning disabilities and/or autism and the rest of the population.
7. We will address the health inequality gap for children living in households with the lowest incomes.
8. We will have a more diverse leadership. 9. We will tackle climate change. 10. We will strengthen the local economy.
They certainly are big ambitions! What an agenda; one can only admire their mission. They state that what will help them to achieve these ambitions is investment in developing a workforce with appropriate skills and tools to deliver the high-quality care that will be required. They will value equality and diversity and ensure inclusion is at the core of everything they do. In addition, they will listen to their staff and communities to ensure services are of high calibre, ensuring decisions are made which are informed by data and intelligence. They promise to use collective resources wisely and to make good use of their buildings. They also identify that they will continue to develop and deliver innovative ideas and solutions in order to improve health and well-being of the population.
The voluntary sector and primary care, as well as the care sector all have very different cultures, not to mention local authorities. They are now working together to deliver the most challenging of ambitions. It is what might be described as a ‘big ask’.
They will consider the impact of poverty, climate change and trauma in the planning of services. The partnership is created from five different
areas and covers a population of 3.4 million people, many of whom have the lowest incomes and could be cast as vulnerable. The partnership has its work cut out.
Integrated Care Boards (ICBs) These Boards are the NHS organisations which are responsible for planning and delivering health services for the local populations. There is one ICB in each ICS. They are responsible for managing the NHS budget working with GPs and hospitals to agree a joint five-year plan which specifies how the NHS will contribute to the ICP’s integrated care strategy. Under the new law, the commissioning organisations, the Clinical Commissioning Groups, are to be abolished and their functions taken on by the ICBs. This is a mammoth task even before the backlog and workforce difficulties. Each ICB has had to provide to NHS England, a joint forward plan (JFP) which it will have devised with its local partners. The West Yorkshire ICB states that, as part of working with people and communities on the Joint Forward Plan,
the ICB must consult the public in a way that is proportionate to the scale of the proposals. Joint Forward Plans will build on and reflect existing Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies and NHS delivery plans, which may already have involved stakeholders in the development.4 The local plan – the Joint Forward Plan – has 131 pages which have been contributed to by five different local ‘place partnerships’, which are Bradford district and Craven, Calderdale, Leeds, Kirklees and Wakefield. They are disparate areas with very different population needs. It is amazing that they have managed to develop a comprehensive plan for future services across areas that have in the not-too-distant past been health service rivals for services. The protagonists have obviously had to adjust the mindset to deliver such a document. NHS Confederation has provided some guidance for ICBs and their partner Trusts to develop their five-year Joint Forward Plans.5
The
guidance sets out a flexible framework, so it seems that the disparity between local partners will continue rather than become one seamless service. This will have implications for the budgets, for services between different areas and also for managing the different elements within one ICS. This deserves to be regularly reviewed by the ICS to ensure it is delivering equally within its boundaries. The Joint Forward Plans are to be reviewed by the ICB annually and either confirmed or refreshed. It is interesting to see that the NHSE is accepting the development of flexible plans as local autonomy has not always been a significant part of the local area’s relationship with the centre, in the past.
Challenges Apart from the challenges noted above in these difficult times, the changes of culture from being commercial rivals for patients and services, as determined in 2012 to the present, working collaboratively does present enormous challenges for all Chief Executives and teams of people delivering services across a broad spectrum of specialties. The voluntary sector and primary care, as well as the care sector all have very different cultures, not to mention local
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www.clinicalservicesjournal.com I April 2024
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