HCL Issue 10 - Page 15

15 announced. Since then, 14 of these have been chosen to become ICSs in two waves, launched by NHS England. Different parts of the country have reached varying levels of integration since STPs were introduced. Senior fellow at The Nuffield Trust Natasha Curry thinks that we will continue to see a level of variation even after April 2021, by which point NHS England aims for ICSs to cover the entire country. ‘The speed at which this transition will happen will vary from place to place and depend on the starting point of the locality,’ she says. ‘When it comes to the target date – April 2021 – we are not going to see the whole country covered by uniform ICSs. Even if they are all known by that label, they are going to look different inside and represent different stages of development.’ The King’s Fund chief executive Richard Murray agrees. ‘I’m sure that up until 2021 and beyond we’re going to see a lot of variation across the country. The STPs that were furthest ahead are likely to remain ahead, while other parts of the country will be slower behind,’ he says. bringing together ‘primary and specialist care, physical and mental health services, and health with social care’. The long-term plan confirmed there will be fewer CCGs, of which there are currently more than 190. In the future there will typically be one per ICS, with ICSs expected to grow out of the current network of STPs. The plan gave an overview of the characteristics ICSs will have, which include a partnership board with representatives from the commissioning, provider, primary care network, local authority, voluntary and community sectors. As part of the NHS planning guidance published in December 2015, 44 STPs were ‘No single formula’ Since STPs were introduced, they have been working towards delivering more joined-up care. NHS England says that it will build on the progress already made by STPs and support them in their transition to ICSs, but it’s not yet clear what this process will entail. ‘At the moment, there’s no single formula for what ICSs should look like. In the long- term plan there are only a few key features about ICSs, what they’ll look like, what they’ll do. I think that’s still an evolution,’ Mr Murray says. Some STPs have become ICSs through devolution – for instance, the Greater Manchester and Surrey Heartlands partnerships – which means they can make decisions locally in response to their population’s needs. Elsewhere, organisations that are part of an ICS have agreed to work with a combined budget, making collective decisions on how their finances should be spent to benefit the local population, such as in the case of Dorset ICS. ‘The process by which an STP becomes an ICS is not outlined in the long-term plan as there is no nationally prescribed, one- size-fits-all model,’ says Cambridgeshire and Peterborough interim STP accountable officer Roland Sinker. ‘However, we are well positioned to evolve into an ICS as we have demonstrated joined-up approaches to planning, such as establishing an STP board in September 2017 and being one of the first STPs in our region to hold STP board meetings in public from November 2018.’ The lack of central guidance doesn’t necessarily mean it will be difficult for STPs to become ICSs. ‘There are different ways of creating ICSs – that’s because they are systems that should reflect local arrangements and context,’ says West Yorkshire and Harrogate Health and Care Partnership ICS lead Rob Webster. NHS England said it will work with NHS Improvement, local government, and voluntary and community sectors to share best practice and help STPs make the transition to ICSs. Although help is available, some think that making the transition within the two- year period is still an ambitious target. ‘It looks tough to me, but we are hopeful that STPs have been maturing towards ICS status. Developing relationships and trust in the context of the current regulatory, financial and operational environment takes time,’ Mr Webster says. ‘Becoming an ICS brings additional freedom and flexibility managing the delivery of local services, and provides better co-ordinated and more joined-up care for patients. We have worked hard on this for nearly three years and have the benefit of exceptional leaders across the partnership in all sectors.’ GP and clinical lead at Nottingham and Nottinghamshire ICS Dr Nicole Atkinson thinks the transition from STPs to ICSs ‘is not going to be an overnight journey’ and that it will take a number of years to work through. ‘It’s going to be a considerable challenge but I think it will motivate people. The challenges that our health and social care system is facing now make the case for integration and transformation a number one priority,’ she says. According to Surrey Heartlands ICS lead Dr Claire Fuller, STPs will be helped in their transition to ICS status by the level of knowledge already available around the country. ‘All parts of the country are at different stages, but the amount of learning that is available will really accelerate change and the transition It’s critical that you spend time building relationships and trust from STPs to ICSs,’ she says. Health experts believe that good relationships between the different partners are also a key feature of a solid ICS. According to Dr Atkinson, ‘it’s critical to spend time building relationships and trust. That takes time, but once it’s embedded, it allows a lot of this work to happen, and people don’t tend to resist the change, they want to be part of it.’ ‘The biggest risk is loss of accountability’ Accountability has been a controversial issue for ICSs. The King’s Fund traces the origins of the term ‘accountable care’ to the US, following President Obama’s healthcare reforms. » Healthcare Leader 2019 Issue 10