A think piece on the NHS legislation proposals from Cllr Tim Swift, Rob Webster and Robin Tuddenham from the West Yorkshire and Harrogate Health and Care Partnership - also known as an integrated care system (ICS).
"As a partnership we welcome the Government’s proposals for the future arrangements placing integrated care systems (ICS) on a statutory footing. We want the future model to work, but for it to do so we believe it essential that it includes flexibility rooted in place, with a core overriding focus on health inequalities and the wellbeing of our whole population.
"Our ICS proudly brings together the NHS, commissioners, providers, local authorities, the VCSE and Healthwatch, at a place and system wide level. All, including local political leaders and chairs of health and wellbeing boards, are influential members of our Partnership Board. Their collective strength provides greater opportunities to deliver on our ambitions, reducing future demand for healthcare by working to ensure that people are given the best start in life, with every chance to remain healthy and age well.
"Our Five Year Plan, co-produced and published in March 2020, and our Improving Population Health Annual Report launched in December 2020, sets out the difference we are collectively making. Both were authored with an approach that sees the NHS plans as one chapter in a bigger story that encompasses the wider determinants of health and harnesses the contribution of all. For example the Board, chaired by a council leader, has made decisions on the allocation of over £2million VCSE funding, with a commitment to deliver on our ground-breaking and independent BAME review which agreed wide ranging recommendations in December 2020.
"Our first ever climate change summit in October 2020 explored how we can reduce the effects of climate change and prepare for its impacts. Our work with public health colleagues on areas, such as violence reduction, suicide prevention, reducing obesity, immunisation and preventing diabetes are core determinants of health of our whole population.
"The social and economic consequences of the pandemic are key to the future wellbeing of our communities in West Yorkshire and Harrogate. The relationships we have with the West Yorkshire Combined Authority for the area’s economic recovery plan, med-tech and the skills sector, including universities, helps us to look at what we can do together to develop and grow our workforce across every element of our system and support people into better jobs via our People Board work.
"This has been possible because we work to a set of overarching principles of subsidiarity, distributed leadership and the primacy of local places, only working together at a system wide level where it makes sense to do so.
"This has been driven by all partners involved equally from the start. From day one, our focus has included equality, equity and improving health and wellbeing for all communities, from early help to specialist hospital care. This is led by an improving population health approach, firmly aligned to joint strategic needs assessment and health and wellbeing strategies, overseen by strong health and wellbeing boards. The latter are a statutory requirement and a great source of collaboration, clinical and political leadership. This in turn is supported by place-based commissioning, ongoing public engagement, our priority programmes and challenge from scrutiny committees.
"The current legal framework for ICS can be clunky, but we are proud to have secured successful political engagement, supported by system assurance and weekly sector lead meetings. Our partnership of equal partners approach has, for example, allowed swift action of local government, VCSE and the NHS during the pandemic. This has meant collaboration to drive change and deliver services, with mutual aid around lab testing, PPE (with the support of the LRF), vaccination, financing and staff resourcing. Over 100,000 people across West Yorkshire who were shielding during the first phase of the COVID-19 pandemic received care and support from councils and community partners.
"The way we work has also enabled greater transparency with meetings held in public with clear accountability and shared responsibility for system wide working. Examples can also be seen in provider collaboratives, including West Yorkshire Association of Acute Trusts, the Mental Health, Learning Disability and Autism Collaborative and our workforce strategies where health inequalities and sector representation is embedded throughout.
"We support the direction of travel on the proposals towards joining up health and care support around the person, based on collaboration between organisations, and where decision-making is at the most local level. We have worked very hard to secure an approach under existing legislation that delivers this. We have also been clear about the need for a long term sustainable solution for social care and have been proud to add our voice to this subject.
"Obviously there is more for us to do and the legislation supports our re-energised system approach into the future. Doing so will require two things specifically.
"Firstly, we must avoid any temptation for ICS to be NHS organisations that look and feel like old Strategic Health Authorities. That would waste the opportunity we have to tackle the issues that face people today, built from individuals, neighbourhoods, places and systems. One where partners work to a shared agenda based on things that matter to local people in their local context. It will be essential that placing ICSs on a statutory footing is accompanied by the flexibility to ensure that at place level there is a strong public voice and that we are able to retain and develop strong commissioning leadership, capacity and skills.
"Secondly, what is good for us must be good for the machinery of central government. A renewed focus from central government on collaboration that supports our collective efforts will be essential. We would want this to work across all departments not just the Department of Health and Social Care (DHSC).
"We believe this is all within reach. We know that our Partnership, and others around the country, are showing what is possible when good rules, good relationships and ambition are met by strong political, clinical, managerial and community leadership."
Cllr Tim Swift is the Leader for Calderdale Council and Chair of West Yorkshire and Harrogate Health and Care Partnership Board. West Yorkshire and Harrogate Health and Care Partnership (WY&H HCP) is also known as an integrated care system (ICS).
Rob Webster is CEO for WY&H HCP and also CEO for South West Yorkshire Partnership NHS Trust.
Robin Tuddenham is CEO for Calderdale Council, Chief Officer for Calderdale Clinical Commissioning Group and Co-chair for WY&H HCP Improving Population Health.