Integrated Care System Association Q & A

When someone mentions an Integrated Care System (ICS), it can be difficult to understand what they mean. They were legally established in England on the 1st of July 2022. Brought in to replace Clinical Commissioning Groups (CCGs) and help achieve a more integrated health and social care service as outlined in the governments ‘Integration and Innovation’ white paper. In England, ICSs are establishing themselves across 42 different locations, as they are designed to encourage regional autonomy.

An autonomy that presents an opportunity for health and care providers to shape the future of integration. However it can be a daunting undertaking that few care providers have the time to engage with. The Integrated Care Systems Association (ICSA) is an independent association founded to represent the chairs and senior clinical leaders of ICSs within the NHS. We sat down with the honorary chairman of the ICSA Dr Anand Chitnis to discuss how social care could make sure it has its voice heard when shaping the future of integration in England.

Trying to decipher your ICS from your ICP and your ICB can make anyone see red and seasick.

“The idea is that the health service is not separate from social care, and that they’ve pulled them together into a decision making and strategic partnership,” explained Dr Chitnis. “But this is the beginning. There are huge hurdles to overcome both in culture, and particularly around finance.”

It is difficult to make the case to the people at the top of an ICS about the validity of any undertaking on the ground level. An ICS is made up of an Integrated Care Board (ICB) and an Integrated Care Partnership (ICP). The former being quite similar to CCGs and the latter being designed to involve a wider range of people in health and social care from their respective communities. We will be focussing on ICPs. Which are strategic oversight partnerships, or as Dr Chitnis put it ‘like a big health and wellbeing board’.

So how do we get them to listen to Social Care?

There is understandable apprehension when it comes to funding and justifying costs in an ICS.

“We, as doctors, know that if you’ve got the social care right, you’d have far less health interventions and far less waiting lists,” Dr Chitnis said. “But that’s not the way the politicians who want quick answers and their votes think we can deal with this.”

Social care has a huge opportunity to demonstrate its value on a national level. Social care is already seen as an effective way to improve delayed hospital discharges. The existing schemes have their shortcomings, but they show the potential for social care to play a defining role in an ICS. This potential aligns with both the government’s 5 point plan and Labour’s 5 missions for Britain. Showing just how relevant social care is to the future, regardless of who is in the premiership.

These systems need to be noticed at higher levels in order to be effective. Social care is largely fractured, and has understandably struggled to gain significant representation on ICPs as a result. An ICP might be a bit overwhelming, but fortunately they are made up of smaller committees called ‘Place Committees’. These in turn contain smaller ‘Locality’ or ‘Community Boards’.

“That’s where you really want care providers to be getting involved,” continued Dr Chitnis. “The board that really makes a difference is the locality/community board. That’s where you’re going to really be talking to the people who are going to be doing the frontline engagement.”

It is no simple thing to propose a way to change the world. When talking to a locality committee you would need to be able to show your methodology and your costs. It would need to be demonstrated on a scale that makes it worthwhile as well.

“Whether it’s a place committee or even at the ICS, no one wants to talk to 100 organisations,” confirmed Dr Chitnis. “No one wants to commission 100 organisations. It’s too difficult. So I would advise forming a collaborative between providers and saying what you can provide as a partnership. You come with that, that’s fabulous, I would be really interested in an association that came to me and said that to me.”

Partnerships or Associations of regional care providers already exist. These could be a potential pathway for collaboration. Geographically linked franchises could be another option.

The key takeaway from our conversation was that despite all the planning and organising, there still remains a lot of uncertainty around ICSs. This also contributes to instances of boards being reluctant to release funding to the local level. However this uncertainty is an opportunity for social care providers.

Social Care partnerships offer an opportunity for providers to join their voices into a chorus. Partnerships can make a collective case to locality boards about the viability of social care based solutions. With specific reference to hospital waiting lists and discharges. Providers displaying how they can offer a transparent, cost effective solution to these pressing issues at a local level can further the understanding of social care’s potential in our communities.

“There won’t be a single way in every ICS,” concluded Dr Chitnis. “It won’t be the same across all the localities at all. I suspect it’s much more going to be what we have found. We have to go to meetings and find out; ‘Who is our ally?’ ‘Who is the person who gets what we’re trying to do?’ ‘Who is interested, and has got influence?’

“Say to them, ‘We can, as a partnership, all meet the standards, we all have DBS checks, we all have the IT ability. You engage with us, you’ll get the right standards that the NHS and public sector demand. We can be your solution at a much more personal level.’

“You come with that, that’s fabulous, I would be really interested in a partnership that came to me and said all that to me.”

In typical fashion it seems social care will need to find its own solutions. But the right partnership, with the right proposal, made to the right people, could be the way to bring positive change and provider led health and care integration to your community.

At the end of the day health and care is rooted in community, and while the system may be unfamiliar, you might already know the people we’re describing.