For the last couple of months I have been working on a report with the County Councils Network on how councils are working with Integrated Care Systems (ICSs). The full report highlights a lot of the differences between ICSs across the country.
During the research, we regularly heard words to the effect that all ICSs were different. As one Integrated Care Board (ICB) chair told us, “if you’ve seen one ICS, you’ve seen one ICS”. In terms of governance and ways of working that was certainly true. But in terms of vision and ambition, councils and ICBs were much more aligned.
Nearly everyone we spoke to highlighted that ICSs should bring a greater focus on out of hospital care and prevention. The most common response in our survey to a question on the top three priorities of an Integrated Care Partnership (ICP) was “public health”, with over half of councils and ICB chairs prioritising this.
What do you see as the top three priority issues for your Integrated Care Partnership?*
|Mental health services
|Hospital admissions prevention
*% of responses that included these issues in the top three
However, our conversations regularly flagged the challenges in prioritising this – particularly in the face of stretched resources and immediate operational priorities. We had many discussions about how investment in prevention would both lead to better outcomes for citizens and reduced costs at a system level, but that the benefits rarely accrued to the organisations making the initial investment. For example, a service run by GPs to identify those at highest risk of diabetes may result in reduced demand in hospitals, so many of the ‘positive externalities’ generated by the GP action accrues elsewhere in the system.
By bringing local government and the NHS together at a strategic level, ICSs should in theory be able to balance and manage those “positive externalities” for the benefit of citizens and services in the system as a whole. But driving action is the challenge. In the report we encourage systems to focus on a small number of ‘inclusive ambitions’ to test the appetite for action across ICS partners and also demonstrate the case for change in this complex space.
Taking action at scale will require resources though. Systems have a tendency to focus on ‘new’ or unallocated resource as the principal opportunity for change. However, IMPOWER encourages systems to examine their existing spend before allocating new resource. Many systems are already investing in preventative services, but this is often spread across multiple delivery partners and focussed on varying cohorts, and as such is not maximising value for money. ICSs offer an opportunity to bring together all those different partners and make that investment more targeted.
IMPOWER has experience of this through our ‘Prevention Spend Mapping’ work, helping systems to focus investment in priority areas. If you would be interested in hearing more, please get in touch.