GUEST COLUMN: Is the prize of joined up health and care within our grasp?

Liz Jones

With 42 Integrated Care Systems (ICSs) being placed on a statutory footing on Friday, 1 July, Liz Jones, Policy Director of the National Care Forum, looks at what the changes mean for real people and what needs to be in place to achieve joined up health and care.

From 1 July, there are big changes to the way health and care services are planned, paid for and delivered as that date ushers in new(ish) entities called Integrated Care Systems. There are 42 of them across England, some very new and some which have been around for longer, but the Health and Care Act puts them on a statutory footing, so if you didn’t have one before, you will now.

What are Integrated Care Systems?

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They are new ‘systems’ designed to achieve the longed-for goal of joining up care and support together for people to give people the support they need, in the right place and at the right time, joined up across the NHS, local councils and other partners.

Their aims sound deceptively simple but hugely desirable – to improve the health and wellbeing of people who live and work in their area, to tackle health inequalities, enhance productivity and value for money and help to support broader social and economic development. They bring the NHS and local authorities together, along with other organisations who have an interest in the care, health and wellbeing of the people in the area.

What is the potential prize here?

For those who have watched the deckchairs of the health system being rearranged over recent years to achieve this joining up, the prize this time might be possible. ICSs offer a real opportunity for all the relevant organisations and services to work together to help people to stay healthy and independent for longer, have more care closer to where people live and work, help to make healthcare and care and support more person-centred, stop the need to keep repeat their story to a series of different organisations to get the care and support they need and helping more people to stay well and avoid needless trips to hospital.

To make this prize a reality, it is essential that social care providers – the people who manage and deliver social care services every day across the country – can play a full role in the new ICSs. System leaders must recognise that social care is a critical part of the health and care system, providing vital services to communities across the local systems. But social care providers are not just organisations that get paid to deliver services – they are also essential to the decision making and planning in local systems, as it won’t be possible to deliver the cherished population health and care outcomes for which ICS leadership is responsible without these key strategic social care partners being actively involved in ICSs.

What do social care providers bring?

Social care providers, especially not for profit providers, are deeply rooted in their local communities. They bring hugely valuable expertise in meeting the current and future needs of their wider communities, as well as deep insight and understanding of the people and communities they serve. Social care is embedded in the lives of people who use it, with more frequent, regular interactions with the social care organisations and their staff over the long term than many NHS services or many councils. This insight is essential if system leaders are to have all the necessary data and approaches to hand to combat health and wellbeing inequalities.

Thinking about helping to support broader economic development, the adult social care system is a major economic driver in the UK, and one of the few areas which contributes to local economies and community cohesion and wellbeing in every part of the country. Skills for Care’s Value of Social Care Report (2021) estimates that the adult social care sector contributes £50.3 billion per annum to the economy in England. It boosts local economies by providing 5% of all jobs in England, with supply chain effects and wages often spent directly in these communities. Care settings are often viewed as ‘anchor institutions’ that generate spending which remains within the same community in which it exists. This spending in turn supports a wide-range of local businesses.

Working together in the ICSs to tackle the health and care workforce crisis is another key opportunity system leaders must grasp. The social care workforce currently sits at 1.54 million according to Skills for Care’s annual workforce report – this is more than the NHS workforce of 1.4 million. Despite the reluctance of the government to accept all the calls for including joint health and care workforce planning in the Health and Care Act 2022, it is pretty clear that the crisis in the health and social care workforce can only be addressed if the recruitment, development and retention of staff is approached in a joined-up way, with meaningful collaboration with social care providers as operational and strategic partners.

This is absolutely essential to ensure the ability to respond to new requests for care, maintain the existing provision of care and support and work together in one system to respond to the increasingly complex needs of the local population.

Will we achieve the prize?

Only if there is a robust social care provider voice within each ICS, at the top table of decision making and at the decision-making layers underneath (the place and neighbourhood arrangements). The plan is to “bring together a broad alliance of partners concerned with improving the care, health and wellbeing of the population, with membership determined locally”. This could be guaranteed with an expectation written into any guidance around ICS governance and partnership working, and backed by the Care Quality Commission (CQC) assurance, that social care providers are meaningfully represented and engaged at all levels – from the operational to the strategic. One route could be through local care associations, or a model like that of the Voluntary, Community and Social Enterprise (VCSE) alliances. Too many of our members currently report being overlooked by their local systems, with very sporadic opportunities to input, despite the experience and ideas they could bring to guarantee integration. We need to start changing the culture to encourage collaboration and integration.

If social care providers are not proactively involved, then we will get what we’ve always had – a shuffling of deckchairs, with the NHS still just talking to itself and unable to improve the health and wellbeing of people who live and work in their area and to tackle deep rooted health inequalities.


Tags : Integrated Care SystemsNational Care Forum
Lee Peart

The author Lee Peart

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