Integrated care, collaborative care and the positive impact of Integrated Care Systems (ICS) are hot topics across the NHS and the wider healthcare space currently! The concept of ICSs is set out in NHS Long Term Plan and described as ‘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.’ With the NHS facing many challenges – not least budgetary pressures and a pandemic - all while managing the demand of an ageing population with long term health conditions, the potential benefits of ICSs are undeniable.
ICSs are part of a major shift in the way the health and care system is organised and will bring about huge changes in how these services are planned, paid for and delivered. With a focus on collaboration and place-based care, they have potential to positively impact patient outcomes.
When the NHS announced the creation of ICSs in June 2019, they had already created several ICSs, and set out their positive impact thus far: ‘ICSs are already helping people to stay healthy and independent for longer, giving more care closer to where they live and work, and improving response times and performance in areas such as cancer and A&E.’
Integrated care is a very positive and appealing concept and will help tackle key challenges being faced by the NHS. Ultimately, the point of ICSs is to improve both patient outcomes and patient experience – so the fact that the patient or citizen is at the heart of the ICS concept is really important.
What does integrated care look like?
While the main aim of the NHS when it was created in 1948 was to treat patients with short periods of illness, now people are living for longer and with more long term conditions, meaning that they need to access more care from different professionals across both health and social care. This means that patients might experience poor treatment because of the lack of collaboration across the healthcare providers. The benefit of integrated care is the joining up of care which will in turn improve the care that patients receive.
NHS England and NHS Improvement (collectively known as NHSEI) wanted to create a vision of what good integrated care look like – and this future really looks bright!
Among the wealth of guidance and reports setting out how ICSs should look, there are lots of visualisations of the positive impacts of ICSs – not least the notion of collaboration between health and social care to enhance care for patients.
‘Integrated care happens when health and care organisations work together to meet the needs of either individuals or local populations,’ with the ultimate and most ambitious aim being: ‘to improve population health by tackling the causes of illness and the social factors that influence health.’
What does it mean for health and care service users?
As a central feature of the current health and care policy and a fundamental shift in the way health and care is organised, ICSs could mean really exciting things for health and care service users. ICSs have been designed to focus on local populations and to bring about major changes in how health and care services are planned, with a clear focus on positive outcomes for health and are service users.
Put simply – this new shift in care delivery across the NHS, social services and the voluntary sector puts health and care service users at the heart of this transformation. As resources are pooled across health and social care, the benefits to health and care service users could be transformative.
ICSs are intended to encourage the NHS and its partners to work differently and make sense of systems, places and neighbourhoods. By providing more services closer to health and care service users’ homes and breaking down barriers between different organisations, the benefits the new ICSs will support greater collaboration and more joined up care.
How joined-up care can benefit patients
Joined up and integrated care can have fantastic outcomes for patients. Take a look at this excellent video by the Kings Fund 'Sam's Story: What if health and care services were more joined up?' The video looks at how people who are ageing have long term conditions had hitherto faced a lack of coordination of care. It gives an example of how – if Sam’s carer is given overall responsibility for coordinating care – this could enable people to better manage their own conditions and from their own homes: place-based care at its best. With care being funded from a joint budget, care plans can be managed better, with a better use of resources across the system.
If a single care journey can be agreed by all people involved in the patient’s care, this will lead to improved outcomes and patient experience. A patient who can be assessed once and have a health and social care team around them that can put this into action, will significantly reduce delay to care.
By ‘reimagining how we provide care,’ the NHS can build multi-professional teams and create systems – that ultimately will support and enhance the patient journey.
Strengthening relationships across ICSs
One of the main aims for creating ICSs - and a potential positive impact of ICSs - is the strengthening the relationships across local areas by providing ‘place-based care’.
Not only are there credible benefits to be seen for patients and health and care service users, there will also be benefits to be seen at the interface between health and care systems. Strengthening relationships across ICSs will lead to a reduction in wasted effort, with better and clearer transfer of information from one professional to another.
A more joined-up leadership strategy will strengthen relationships across the ICS, as will a leadership which recognises, and can put in place, the right care arrangements at a local and regional level.
A multi-agency approach will provide benefits – as will collaborative working - which can bring together a wide range of partners to join up the planning and delivery of services. ‘Experience suggests that much of the work involved in integrating care and improving population health will be driven through these more local partnerships.’
Capture and spread the impact and learning
Clearly there is a lot to take on board and to navigate in the creation of ICSs – but how can we capture the impact and learning – and reap the benefits for both the NHS and the patient?
There are a wide range of things people who are creating ICSs or integrated care partnerships (ICP) can do. Organisations like the Kings Fund are putting together documents and resources to share learning. You can join learning networks - such as the King’s Fund’s Learning Network - which has been developed to support ICSs and offers an opportunity to join peers facing similar issues and to learn from successful examples both from England and internationally.
In this article we’ve looked at the benefits that will occur if ICSs are aligned and implemented well. There are many tangible and practical benefits for the whole population, particularly for the growing number of people living with multiple long-term conditions. They will also improve financial efficiency, by sharing resources and reducing duplication as: ‘A system that pools knowledge, expertise and financial resources is better equipped to meet future demand in these financially challenging circumstances.’
So, the changes to the way that services are funded and delivered will benefit many. Once established and in place, ICSs will be ‘helping to support people in the gaps between health and care that enable individuals to recover faster from illness or injury and maintain a better, more fulfilling quality of life for longer by being in the right place at the right time for care to be delivered.’