Building strong integrated care systems everywhere

ICS implementation guidance Integrated care systems (ICSs) are partnerships of health and care organisations that come together to plan and deliver joined up services and to improve the health of people who live and work in their area.

They exist to achieve four aims:

• improve outcomes in population health and healthcare

• tackle inequalities in outcomes, experience and access

• enhance productivity and value for money

• help the NHS support broader social and economic development.

Following several years of locally-led development, and based on the recommendations of NHS England and NHS Improvement, the government has set out plans to put ICSs on a statutory footing.

To support this transition, NHS England and NHS Improvement are publishing guidance and resources, drawing on learning from all over the country.

Our aim is to enable local health and care leaders to build strong and effective ICSs in every part of England.

Collaborating as ICSs will help health and care organisations tackle complex challenges, including:

• improving the health of children and young people

• supporting people to stay well and independent

• acting sooner to help those with preventable conditions

• supporting those with long-term conditions or mental health issues

• caring for those with multiple needs as populations age

• getting the best from collective resources so people get care as quickly as possible.

About this document

This guidance is for health and care leaders from all organisations in ICSs that are developing partnerships across local government, health, housing, social care and the voluntary, community and social enterprise (VCSE) sector. The ICS design framework sets the expectation that integrated care board (ICB) governance and decision-making arrangements support close working with the VCSE sector as a strategic partner in shaping, improving and delivering services, and developing and delivering plans to tackle the wider determinants of health. This guidance provides more detail on how to embed VCSE sector partnerships in ICSs.

Key points

• The VCSE sector is a key strategic partner with an important contribution to make in shaping, improving and delivering services, and developing and implementing plans to tackle the wider determinants of health

• VCSE partnership should be embedded in how the ICS operates, including through involvement in governance structures in population health management and service redesign work, and in system workforce, leadership and organisational development plans.

Foreword: communities at the heart of health and care systems – the essential role of the VCSE

The COVID-19 pandemic has given society its biggest challenge of the past 70 years. It has shown that people need support joined up across local councils, the NHS and voluntary organisations. Initiatives to bring support to people in their communities have been most successful when partners have bridged traditional divisions between health and care and the voluntary sector. The pandemic has highlighted the value of this work.

Some of the most exciting and innovative work I have seen has been in the voluntary, community and social enterprise sector (VCSE). A strong focus on health and wellbeing, social connection and having fun!

In Wigan, we created a social contract between citizen and state

– The Wigan Deal – bringing communities and local partnerships together.

As part of this, we took an ‘invest to save’ approach to strengthen the role of the VCSE sector in prevention and community resilience. We set up a community investment fund for VCSEs and gave council officers freedom to work with communities in an innovative way.

Council cost–benefit analysis estimates that for every £1 spent through the fund, £2 of fiscal value is created. This includes direct savings to social care, crisis savings and benefits payments.

Our approach was to join the dots around people and place, cutting through the complex proliferation of initiatives and departmental solutions.

This is what we learned:

• Find out what’s important to residents and listen closely to communities. They will make the right decisions about their own lives with the right support.
• Invest in local community grassroots organisations and relationships with families to truly help people and reduce demand for expensive, ineffective and clunky state solutions.
• Give the freedom to test new approaches in integrated place-based teams, such as the self-organised Buurtzorg model in neighbourhoods. Trust public servants to work with people.
• Reduce time and money spent on passing people around the system for further assessment and referrals to another agency to deal with part of their problems.

It is important to understand that many VCSE organisations are struggling financially because fundraising has been adversely affected by the pandemic, at a time when demand for their services and support has never been greater. Positive engagement with the VCSE sector now can ensure that their knowledge, expertise and networks are protected, for the benefit of the whole community.

Frontline workers in VCSE sector organisations, together with their public sector colleagues, want to help people and improve their lives. We need to tap into their creativity and resilience and set them free to cut across the artificial organisational barriers of health, care, housing and criminal justice. If we do, the future is much more exciting!

Professor Donna Hall, CBE Chair New Local Government Network and Bolton NHS Foundation Trust

For the full document please download the attachment.

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