https://socialcare.blog.gov.uk/2018/03/08/integrated-care-systems-are-the-next-big-thing/

Integrated care systems are the next big thing…

…but what do they mean for social care? That’s the question Ewan King is asking in his latest blog for DHSC’s Social Care News.

Ewan King is Director of Business Development & Delivery at the Social Care Institute for Excellence (SCIE)

Integrated Care Systems and Integrated Care Partnerships – until recently accountable care systems and partnerships – have become the latest in a long line of buzz words used to describe changes in the NHS.

Some concerns have been raised, including by none other than Stephen Hawking. But before we go into these arguments, is it time to step back a little and explore what it means in practice for social care?

According to The King’s Fund, integrated care takes place when ‘different organisations from the health and care system work together to improve  local population health by integrating services and tackling causes of ill health.’

In terms of how services are commissioned, integrated care is likely to lead to a shift away from annual contracting rounds, underpinned by payment by results, towards longer term, outcome-based contracts.

Building relationships

This definition is brought to life by Rob Walsh, joint Chief Executive of North East Lincolnshire’s Council and CCG, who told me: ‘For accountable care [integrated care] to work effectively, key partners in the system need to build credible and resilient relationships and be very clear… about how resources can be combined to maximise local impact.’

How local areas develop accountable care varies, with approaches differing from, on the one hand more formal mergers between organisations (accountable care organisations), to, on the other, looser alliances between NHS and local government organisations (integrated care partnerships).

To make the picture more complicated, NHS England has also launched integrated care systems (ICSs) which will emerge from Sustainability and Transformation Partnerships (STPs) and deliver integrated care across often large geographical areas.

What about social care?

So far, much of the focus has been on what this means for the NHS, with debate driven by health-aligned think tanks, with less said about the implications for social care. So what are they? The key themes seem to be:

  • Increased focus on integration of health and care, with a speeding up in the development of fully integrated, community-based, multi-disciplinary teams which deliver personalised care to patients, service users and carers.
  • More time being spent by social care leaders on working across organisational boundaries. This is what is known as ’systems leadership’, which involves leaders spending less time simply leading their own organisations, and more time working with other organisations to deliver better services.
  • More integrated commissioning, whereby local government and health commissioners agree to combine their resources – often in large pooled budgets – and commission services to meet agreed outcomes for the whole population.
  • Ambitious plans for preventative, community-based care that is delivered closer to, or within, people’s homes, such as wellbeing teams and Shared Lives (support in people’s homes).

Engaging with the new agenda

Integrated Care Systems are not without critics, with some concerned it will lead to backdoor privatisation. Others worry about social care being subsumed within medicalised NHS model of care.

On the issue of privatisation, both The King’s Fund and the Nuffield Trust have denied this is taking place, with Chris Ham writing: ‘Our work suggests that widespread privatisation is highly unlikely and that accountable care is a promising way of integrating care and improving population health.’

There is also evidence in some places, such as Greater Manchester, that the drive towards integrated care systems, has come in parallel with a stronger focus on improving social care and developing person-centred care systems.

The way forward, it seems, is for this agenda to be embraced by social care leaders. David Pearson (Corporate Director, Adult Social Care, Health and Public Protection, Nottinghamshire County Council) told me: ‘Here in Nottinghamshire we believe we are - and seen to be - up for innovation and ready to take measured risks on accountable care.’

It may be early days, but I believe the opportunities are there to make sure integrated care means exactly that: health and social care systems working together to deliver joined-up services for everyone who needs them.