We have seen structures and priorities change across the evolution of the NHS over recent decades, but some ambitions have remained constant.
One of those has become a centrepiece of the current changes sweeping through our National Health Service; the prevailing view that people are better served by public services which are integrated and have a greater focus on prevention.
We have never had a better opportunity than the one facing us now to deliver life-changing integration with the NHS, but this won't come without all of local government seizing the day.
London stands ready to take advantage of this opportunity to improve the health of the people we represent. Integration was a key part of our 2017 devolution deal with national partners, allowing us to harness the best of London's local government and health systems to move forward in our ambition to join up the planning and delivery of services. Boroughs haven't stood still since then and have continued to work closely with the NHS to develop collaborative models of working.
COVID has been a trial by fire for those local relationships but councils and health partners across London are united in telling the overwhelmingly positive story of how those local relationships served them and their communities throughout the pandemic. Boroughs have come together with the NHS and community groups across the capital to achieve amazing things as they protected Londoners who were shielding, supported homeless people through Everyone In, and delivered the vaccination programme and a range of other support schemes.
But we know we can go even further. At London Councils we knew that we needed to identify what lessons could be learnt from partnership working over the past two years to ensure that the way these relationships have evolved can be mainstreamed into how boroughs and NHS colleagues design and deliver new models of integrated working through Integrated Care Systems (ICSs) and place partnerships. In partnership with the NHS in London, UK Health Security Agency, the Greater London Authority and PPL, London Councils has undertaken a system-wide review of what we have learned, talking to a wide range of health and care leaders.
The outcome of this work is included in a report we have launched setting out the Five Ps (Purpose, Priorities, Place, Pounds and Providers) for integration.
The Five Ps provide organising principles to describe London's next steps to increasing integration in a meaningful way. Intrinsic to all of these is People - the sixth P.
Purpose – in our review we heard a strong response which said why can't we make addressing inequalities the central purpose of London's five ICSs? In practical terms, this could mean that we put addressing inequalities at the heart of how we fund, plan, deliver and assure services and how we measure the overall success of our ICSs and ICPs.
Priorities – people felt strongly that, as partners, we should agree in each place partnership a small number of priority outcomes linked to this purpose which we will deliver in the next 12 months. Perhaps priorities could be set at a borough level from a list of outcomes that can only be achieved by partners working together, based on the needs and priorities of all of our communities.
Place – In London we are now agreed, in the context of the health reforms, that Place means boroughs and that our 32 boroughs will be the heart of our local health and care systems. In practical terms, this would mean that place partnerships are enabled by ICSs who support them to have financial and decision-making autonomy, whilst enabling collective efforts on shared priorities and best practice.
Pounds – We found strong support for a commitment to pooling all local health and care budgets by default, except where there is a compelling reason not to. This would enable all partners to show how investment is growing in community-based prevention and early intervention, improving outcomes and reducing long-term costs.
Providers – We heard clear and consistent support for provider collaboratives and primary care networks to deliver better outcomes at scale and within places. In practical terms, this could mean that the voice of primary care is reflected in decision-making at all levels, with PCNs providing the ‘hub' for local care networks that focus on the wider needs of individuals and communities.
The final and central part of this framework is People. The people who make up the essential relationships for delivering the aspirations we share for how integration could be harnessed to the public good of all Londoners. This means that democratically accountable community representatives need a strong role in the new systems and structures so that we can make best use of the wider powers boroughs have to affect the health and wellbeing of people, from housing, to environment, to public health, to education and to social care. We have a powerful contribution to make.
The recent health and social care integration White Paper provides much needed clarity, and we welcome the continued acknowledgement from the Government that place based partnerships will be crucial in the delivery of joined up services. Improvements to data sharing will make us more effective and support better outcomes for our residents. But it is also important to remember that these changes won't come for free and we therefore look forward to seeing more detail about how the reforms will be funded. In particular, we would welcome detail on how systems will be supported to resolve workforce challenges across the health and care sectors.
There is a lot to get right before we are ready to make the most of this opportunity, and there is no doubt that local government will need to step up to the plate. But the time is now and London boroughs are ready to seize the day alongside a willing health service.
Cllr Danny Thorpe is London Councils Executive member for Health and Care
