The NHS Long Term Plan, published in 2019, confirmed that all parts of England would be served by an integrated care system from April 2021. ICSs are partnerships of NHS organisations, councils, and key partners from the voluntary, community and social enterprise sector, working together across a local area to meet health and care needs, coordinate services and improve population health. CCGs are partner organisations in the Lancashire and South Cumbria ICS, working to improve health and care services and help the 1.8 million local people live longer, healthier lives.
NHS England and Improvement’s white paper Integrating care: Next steps to building strong and effective integrated care systems across England (February 2021) details how ICSs, and the organisations within them, will work more effectively and more collaboratively in future. It also reflects on the insight received from a range of local leaders, including the impact of the COVID-19 pandemic. The key building blocks of integrated care include strong partnerships in local places and neighbourhoods with a focus on improving the health of our population. Working at system level has already demonstrated benefits locally, such as the response to COVID-19, the new hospitals programme and managing the system’s financial deficit.
Partners in Lancashire and South Cumbria have a shared vision for the continued development of partnership working at all levels. A key step towards enabling single strategic commissioning decisions was the recent agreement to establish a Strategic Commissioning Committee, supported by a limited number of sub-committees. The national proposals are in line with the efforts being made locally to improve the health and wellbeing of the whole population, improve outcomes and quality of services and work towards the financial sustainability of local services.
All NHS provider trusts are expected to be part of a provider collaborative in order to help set system priorities and allocate resources. Since October 2020, the System Leaders Executive has been overseeing a System Reform Implementation plan for Lancashire and South Cumbria. The plan will include proposals for provider collaboration within acute hospitals and mental health services, plus details of the commissioning reform process.
Along with the commissioners and trusts, local authority partners are part of the senior leadership team and ICP Board which oversees the plans and decisions of each of the five Integrated Care Partnerships (ICPs) in Lancashire and South Cumbria. As strong and effective place-based partnerships, ICPs have four main roles:
- To support and develop Primary Care Networks.
- To simplify, modernise and join up health and care.
- To understand and identify people and families at risk of being left behind and to organise proactive support for them.
- To coordinate the local contribution to health, social and economic development to prevent future risks to ill-health.
This year, the Lancashire and South Cumbria Integrated Care System Board approved a core narrative for Integrated Care Partnerships and sponsored the second phase of organisational development for place-based decision-making.
In July 2019, every GP practice became a member of a Primary Care Network (PCN), working together to provide care for their local populations. During 2020/21, further national specifications were added to the Direct Enhanced Service (DES) network, including structured medications review and optimisation, enhanced health in care homes and supporting early cancer diagnosis. PCNs have been pivotal in the rollout of the COVID-19 vaccination programme, with 36 PCN vaccination centres operational across Lancashire and South Cumbria – eight on the Fylde Coast.
Partnerships across the voluntary, community, faith and social enterprise (VCFSE) sector and public services have been developing over the past three years. In Lancashire and South Cumbria, we have benefited from being involved in a number of national initiatives for learning and developing equitable partnerships. The VCFSE sector have been developing partnerships in each of the five ICPs, with a VCFSE Alliance at system level with representation from elected leaders to enable engagement at a Lancashire and South Cumbria level.
During the pandemic, a significant number of residents reported to Healthwatch a worsening of physical and mental health issues related to lockdown, including loneliness, anxiety and depression. NHS and local authority partners in Lancashire and South Cumbria worked with local VCFSE partners to promote relevant support services and events that would benefit the health and wellbeing of local people.
Other developments during 2020/21 include securing funding for an Independent VCFSE Alliance Chair and to support involvement from the sector at ICP level. The Institute for Voluntary Action Research was also commissioned to undertake a ‘Test and Learn’ research project to understand the maturity of VCFSE and PCN development. The ICS has hosted meetings and development days for the VCFSE Alliance, and the VCFSE sector is included in service planning and co-design of ICS programmes.
The ICS Clinical Strategy has been co-produced with clinical and non-clinical leaders through a range of workshops and leadership discussions. These have involved medical directors and a range of partners including primary care, the VCFSE sector, ICP leaders and medical directors. In summer 2020, a process of clinical validation was undertaken with those involved in the co-production to ensure their contributions had been reflected
The Clinical Strategy comprises six core areas: health and wellbeing of our communities, living well, managing illness, urgent and emergency care, end of life care including frailty and dementia, and workforce. The Strategy will enable the ICS to work towards financial balance as well as delivering improved care for patients. It is a key building block of the development of integrated care in Lancashire and South Cumbria which will continue throughout 2021/22.