The Journey to Becoming an Integrated Care System (ICS)

Shropshire, Telford and Wrekin Sustainable Transformation Partnership (STP) became an Integrated Care System (ICS) from 1^st April 2021. In an integrated care system, NHS organisations, in partnership with local authorities and other partners, take collective responsibility for managing resources, delivering NHS care, and improving the health of the population they serve.

Our Partnership consists of the NHS (NHS Shropshire, Telford and Wrekin Clinical Commissioning Group, The Shrewsbury and Telford Hospital NHS Trust, The Robert Jones Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Midlands Partnership NHS Foundation Trust, Shropshire Community Health NHS Trust and primary care/GPs), our local councils (Shropshire Council and Telford & Wrekin Council), along with the voluntary sector and other core partners involved in transforming the provision of health and care services across Shropshire, Telford and Wrekin for those we serve.

We are on a journey to create a much more integrated system across Shropshire, Telford and Wrekin, working as a multi-organisational partnership both in terms of planning and commissioning services across our population, and in developing more integrated services on the ground.

The central aim of an ICS is to integrate care across different organisations and settings, joining up hospital and community-based services, physical and mental health, and health and social care. This more joined up ‘integrated’ approach brings real benefits to patients.

Our current ICS Shadow Board meets monthly and shares accountability for an agreed set of health and care outcomes and impacts. The board will become the ICS Board effective of the 1^st April providing extra clarity to decision making at a system level in a way which complements our existing boards and councils.

Through the ICS Board, Independently chaired by Sir Neil McKay, the system will be publicly held to account for better prevention and outcomes for people in Shropshire, Telford & Wrekin; making sure that wherever possible, care is provided as close to people’s homes and local communities as possible.

Whilst there is more work to do to create a truly integrated care system, it will bring about more improvements in health outcomes for local people, reducing health inequalities, promoting continuity of care, and making practical improvements to people’s lives, as well as creating more support, time and space for staff to collaborate and deliver their role more effectively, in a safe and compassionate way. The ICS will be able to do this by looking at the wider determinants of health and wellbeing, in a much more joined-up and unified way.

We have made great progress developing our relationships and working together over the last few years. We already have some great local examples such as the Multidisciplinary Care Home Team in Telford and Wrekin which includes care home staff working closely with primary care colleagues to deliver enhanced support to those in care homes across Telford, utilising digital technologies to enable remote consultations. The team offers education to care home staff, proactive care planning for residents and support for individuals to remain within their care homes, rather than in hospital, at the end of their lives.

In Shropshire, Public Health, the Voluntary and Community Sector and Primary Care have been working collaboratively to develop and roll out a social prescribing model that supports people in the community where they live. This model is preventative in its approach as it supports people with their emotional wellbeing and supports them to have the confidence and motivation to take positive lifestyle decisions.

Many of our integrated ways of working have been accelerated in our collective response to COVID-19 and we want to continue to embed and accelerate this joint working through our ICS development plan.

The benefits of becoming an ICS are:

1. Improved outcomes and patient experience, ensuring a single journey that’s agreed by the teams involved in their care. This should significantly reduce the delay and debate that occurs in the current system – something which can cause individuals to ‘fall through the cracks’, exacerbating demand and poor outcomes.

2. The opportunity to create a reduction in wasted effort, improve transfer of information from one professional to another, fewer overall transactions and more joined-up leadership which recognises, and can help put in place, the right care arrangements at a local and regional level for their populations.

3. Improved financial efficiency gained from a system that pools knowledge, expertise and financial resources. An ICS is better equipped to meet future, and in some cases (as we’ve seen during the coronavirus pandemic), unexpected demand on services in what are already financially challenging times. The savings gained can then be used for new services and initiatives that support preventative measures and public

Our ten pledges set of our integrated care system delivery plan:

1. Improving safety and quality - making sure our services are clinically safe throughout the system, delivering the System Improvement Plan and tackling the backlog of elective procedures as a system.

2. Integrating services at place and neighbourhood level - developing local health and care hubs to improve not just the physical but mental health of people, build on the principles of one public estate and the assets of individual communities, better manage the volume of hospital admissions and establish new models of care to best serve all our communities.

3. Tackling the problems of ill health, health inequalities and access to health care
   
   
4. Delivering improvements in Mental Health and Learning Disability/Autism provision

5. Economic regeneration - we aim to harness the potential of the health and care system together with wider public services to contribute to innovation, productivity and good quality work opportunities. In turn this will create economic prospects that will help improve the health and wellbeing of our population.
6. Climate change - we will consult on a multi-agency strategy setting out our response to the threat of climate change.
7. Leadership & Governance - we recognise that how we deliver and make decisions needs strengthening throughout and therefore we will review and revise our ICS Governance arrangements with an emphasis on place, neighbourhood and provider collaborative arrangement.
8. Enhanced engagement and accountability - we will increase our engagement, involvement and communication with stakeholders, politicians and the public.
9. Creating system sustainability - Building upon the work included in our LTP, we will produce a sustainable ICS Financial Recovery plan by April 2021 alongside a System People Plan committing to recruiting and retaining the best people in a supportive working environment.

10. Workforce - making our system a great place to work by creating environments where people choose to work and thrive and by building system leadership and a flexible co-operative workforce.

For more information about Integrated Care Systems visit www.england.nhs.uk/integratedcare.

Sustainable Transformation Partnerships and Integrated Care Systems

In 2016, NHS organisations and local councils came together to form sustainability and transformation partnerships (STPs) that cover the whole of England, setting out their individual proposals to improve health and care for patients.

For the most advanced STPs, integrated care systems (ICSs) are the next step; representing a more advanced level of integration and system-wide working. From the 44 STP footprints, 18 ICSs have already emerged, meaning around half of the country’s population is now covered by an ICS.

In an ICS, NHS bodies (commissioners and providers), local authorities and third-sector providers each take collective responsibility for the management of resources, delivering NHS standards and improving the health of the population they serve.

When different organisations work together in this way, local services can provide better and more joined-up care for patients. ‘Systems’ can better understand data about local people’s health, allowing them to provide care that is tailored to individual needs. For staff, the improved collaboration can help to make it easier to work with colleagues from other organisations.

The NHS Long-Term Plan

The NHS Long-Term Plan sets out the ambition that every part of the country should be an integrated care system by April 2021. In order to mature into an ICS, sustainability and transformation partnerships (STPs) must achieve objectives in three core areas. These include:

1. Building wider partnerships with local government and other community partners, to better understand data and other intelligence about the health and well-being of all people in their area. This allows for improvements in day-to-day physical and mental health, as well as reductions in health inequalities between different groups.

2. Creating capacity for implementing the system-wide changes that will improve health results and quality of care, by taking on shared responsibility for how they use their collective resources, including agreed cross-system spending totals.

3. Improving quality and access to care by managing NHS resources more efficiently and effectively – in order to improve health outcomes and reduce inequalities (in quality, access and outcomes).

To find out more about what integrated care systems are please watch the below videos from NHS England and NHS Improvement:

• Integrated Care: https://www.england.nhs.uk/integratedcare/
• Strong Integrated Care Systems Everywhere: https://www.youtube.com/watch?v=mz4FFE2y8PM