Local government and integrated care

For those councillors in local government who scrutinise the NHS, it seems to have become an expectation that as one great change ends in our local health services, another begins.

A good few years ago in north-west London, we saw the start of the sustainability and transformation plans, later rebranded as sustainability and transformation partnerships – or STPs, as they were widely called. 

Now it seems another change is on the way. By April 2021, an integrated care system (ICS) will have been introduced, taking forward much of what was developed by the STPs. ICSs are coming at a time of incredible change for the NHS and local government as a result of dealing with the COVID-19 pandemic.

An ICS brings together health providers and commissioners, along with local government, to plan healthcare based on local population health needs in a defined geographical area. 

I’ve noticed the term ‘place’ features frequently in the NHS documentation and published reports. The underpinning and thinking for them is set out in the NHS Long Term Plan. 

They started in 2018 in a few areas and around half of England’s population is now covered by an ICS.

“Thinking about the ordinary residents in my ward, what will an ICS deliver for them?

As for my local proposed ICS, this will cover around 2.3 million residents across eight boroughs in north-west London, stretching from Westminster to Hillingdon, with multiple providers, community healthcare trusts, clinical commissioning groups and local authorities. 

What I want to address here is this: how does an elected member sitting on an overview and scrutiny committee start getting to grips with effectively reviewing and holding to account the development of a ‘system’ of such complexity, and in the constraints of the time and resources we all know elected members face? What should our starting principles be? 

It’s not easy to answer, but I have a few suggestions.

As an elected member, I don’t necessarily need to worry about being a ‘systems thinker’ but I do like to test their thinking constructively. I would perhaps ask this: thinking about the ordinary residents in my ward, what will an ICS deliver for them? What will it do to make them and their families and children healthier, and be able to live longer and with a better quality of life? 

For me, that’s what organisational systems in our public services should be about – simply a means to an end of delivering something better for ordinary people and our communities.

Also, while we talk about ‘systems’ in health services, let’s not forget that when we refer in particular to hospitals, we are often talking about important institutions which command a lot of local pride and attachment – and not just because of the services they provide, but because of the outstanding research they do. Also, in my home borough of Brent, they are important local employers. 

I think this way of looking at the world from the grassroots should not be lost in these changes.

So that’s a few ways we can start to get to grips with such a big change, and complexity. Then it might be time to prepare for the next one, whatever that may be.

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