The Health Devolution Commission is calling for a third ‘Health and Prosperity' model of Integrated Care Systems in its response to the recently ended NHS England (NHSE) consultation. Co-chairs Andy Burnham and Norman Lamb call for dispensing with ‘the technocratic term' Integrated Care Systems and adopting the title Integrated Care Partnerships to reflect that the next iteration of reform must be predicated on a genuine and accountable partnership between the NHS and local government as well as clinical and third sector stakeholders.
The Commission broadly welcomes NHSE's proposals as a major step forward towards its own vision of comprehensive health devolution and collaborative ways of working. But there is a strong case for going further to give local areas more choice about the nature of their local system in order to deliver integrated NHS and social care services, and build healthier and more prosperous communities.
Andy Burnham, Mayor of Greater Manchester and former Health Secretary, believes the COVID pandemic has shone a spotlight on the need for reform of the social care system, which, despite the incredible sacrifices and efforts of many thousands of outstanding staff, has been broken for a long time. But surprisingly, the integration of NHS with social care services is not centre stage in NHSE's proposals and is an opportunity missed.
The Commission also agrees that the pandemic has demonstrated the need for a ‘health in all policies' approach, and that the best way to improve the system is by building on local partnerships which are already working. A third statutory ‘Health and Prosperity' model of Integrated Care System bodies extends the two options being proposed and gives more autonomy to local ICS bodies to be a genuine ‘partnership of equals' to tackle health inequalities.
The Commission's proposal for a third ICS model also reflects the reality of how devolution in England has already been taken forward by other parts of government: The Ministry of Housing, Communities and Local Government has devolved power and budgets to sub-regional geographies and these are also the best way to deal with health and social care issues in those areas.
Co-chair Norman Lamb is concerned that reform of ICS bodies could become a technocratic re-arrangement of traditional ‘command and control' in the NHS. In this version of the future, ICSs would become mini-Strategic Health Authorities clinically led and primarily accountable to NHSE or central Government. Instead, the Commission argues that reform of Integrated Care Systems must lead them to embrace a wider purpose to include better social care and public health services, tackling health inequalities and improving economic prosperity.
Integrated Care Partnerships (ICPs) should seek to embed the principles of person-centred care, active citizen engagement, and ‘health in all policies' in their ways of working. They should ensure parity of esteem between physical health, mental health, social care and public health. Local democratic accountability should be enhanced through joint civic and clinical leadership in a ‘partnership of equals', made real through single health and social care budgets and commissioning at the locality level.
The Commission's proposed ICPs should be built around the best alignment of new ICS body footprints with established boundaries of Local or Sub-Regional Government and they should also embrace health and social care workforce planning and management.
The welcome replacement of competition with collaboration in health services will require the establishment of robust local external scrutiny arrangements alongside local democratic forms of accountability. Accountability for local partnerships delivering a set of national entitlements to health and social care would necessitate a mature ‘two hands on the tiller' partnership way of working between central and local government perhaps through a public joint health mandate for each area.
The Health Devolution Commission completed its original report last summer and has agreed to be re-established as a Standing Commission. Moving forward, it is now keen to contribute the experience and expertise of its members and partners to work with national and local Government, the NHSE and wider stakeholders in developing its proposals further. A main priority going forward will be thought leadership and further research regarding the Commission's third ‘health and prosperity' model of ICS bodies as an option for local partners to adopt.
Steve Barwick is director of the Health Devolution Commission, and Phil Hope is former Health Minister and lead author of the report Integrating care: a unique opportunity to build back better health and prosperity.
