How to amplify the local government voice within integrated care systems – reflections from LGA 2022

This week at the 2022 LGA conference, senior leaders from the NHS and local government discussed the risks and opportunities the development of ICS (integrated care systems) pose for local government leaders. How effectively are NHS leaders and local authorities working together, and how can ICS be a partnership of equals, with a shared vision and accountability for enhancing population outcomes and minimising health inequalities?

Whilst there is rightly high aspiration around the opportunities for ICB’s and ICP’s to drive down health inequalities, centred around an equal partnership between local government and health, it is clear that very different cultures – particularly around governance and local democracy, continue to challenge the aspiration becoming reality on the ground. Implementation frameworks have been built to be ‘permissive’ to provide flexibility and agility to local areas given the complexity of local systems, but the discussion at the LGA conference highlighted a number of local areas continue to feel access and influence with health is tough and can feel intransigent.

For years local government has focused on adaptive change – continually transforming service models to meet austerity, demand, and demographic challenges. Meanwhile health undergoes broader, significant structural change when external factors mandate it. This is at the heart of the cultural and behavioural differences between the two sectors and needs to be overcome to maximise the opportunities around ICP’s. Two thoughts resonated in overcoming these differences and seeking to create a new culture of trust and collaboration:

1. Local government needs to show tenacity in continuing to push for adaptive change on the ground, identifying quick wins to build momentum.

For example, there is an excellent opportunity to develop more integrated discharge hubs which would include services such as leisure and housing as well as social care. This would support quicker discharge and create more focus on person-centred care. Additionally, there is an opportunity to maximise retention and improve response to workforce challenges by building more agile career pathways across the health and care interface.

2. Local areas should push harder to put the voice of those with complex needs at the heart of system design as a driver for cultural change.

One way this can be achieved is through greater harnessing of qualitative sentiment. Rolling out innovative tools like IMPOWER’s Listening Tool will bring the voices of those with complex needs, those whose lives are deeply affected by system inequalities, to the fore.

However, listening alone is not enough – these insights need to be properly integrated into system design and decision-making. Qualitative insights can and should be brought into discussions at strategic board meetings, to promote a more democratic design process where citizens participate in the development of new models of care. To properly assess whether a new model of care is working, people that are using services should also be part of implementation review.

The challenges feel really tough at the moment. Process, constitution, and governance can’t solve them all. We need to use data and insight – including the citizen voice – to set a clearer ‘inclusive’ ambition between health and local government, which includes the ability to measure progress at a macro and micro level. We are already helping a number of areas do this, if you would like to know more, please get in touch.