The long view for Integrated Care Boards

Some strategic questions for the longer term

Integrated Care Boards (ICBs) were established on 1 July 2022 taking over the functions of former Clinical Commissioning Groups (CCGs). Here, we look forward to what happens next as we enter a transitional period offering an opportunity for the benefits of system working to be explored, and creases ironed out. What are some of the key questions for ICBs to consider during this time?   

1. How can we promote stronger integration at Place level?

Over the past few months Places have worked hard to set up arrangements to ensure a “safe landing” from 1 July. But what next? How can an ICB drive more integrated decision-making at Place?  This is key not only to improving health outcomes but also to the ICB’s success as an organisation. Crucially, the Care Quality Commission (CQC) will be assessing ICBs according to how well their Places operate.

Bearing this in mind, ICBs must continue in their efforts to think beyond the safe landing to what they would like their Places to achieve in the longer term. For most, this will be a deepening of relationships between the Place partners and this trust building exercise will ideally be reflected in greater pooling of budgets and genuine joint decision-making. Part of this process will involve tackling the “wicked issues” in the post-Covid landscape which will not be comfortable territory for partners. ICBs will need to encourage and enable their Places to move beyond their landing point to evolve as genuine partnerships to address these issues.

On a physical and practical level, one of the best and most natural ways of promoting stronger integration is by teams working together in the same space. Sharing a building can improve communication, increase the exchange of ideas and create a sense of community amongst employees. Add into this a joint management board that senior people from the different organisations, who also occupy the building, sit on and that sense of community is taken to another level. The parties can then oversee the running of the building so that all parties have a say in its development, its culture and who, in the future space should be let to. 

To get this absolute integration an understanding of the estate and its legal constraints and possibilities, is fundamental. As is defining the sharing relationship between the parties so that there is clear understanding of responsibilities and potential liabilities as working relationships develop. Bearing this in mind, one of the first exercises it is crucial for ICB’s to undertake is a review of the property portfolio that sits beneath it so that it understands the terms on which it is held and how it can be used going forwards.

2. How do we embed the use of data into our culture?

The strong focus on population health management and the prevention of ill-health, emphasised again in the Integration White Paper, means that ICBs need to have access to useful data to inform target outcomes and decision-making. The fundamental building blocks of this work often feel very distant from the front line, and can be very expensive. They also require a cross-organisation approach as it is essential that data can be collated and accessed across different organisations. The development and implementation of the ICB’s digital strategy is therefore key and this is underlined by the Department of Health and Social Care’s recently updated Policy paper – Data saves lives: reshaping health and social care with data.

ICBs can also consider how their data experts will input into decision-making across the Integrated Care System (ICS) and Places. How can decision-makers access the data they need?  How can data analysis lead the ICB’s priorities, in particular around health inequalities? How can the impact of the ICB’s approach be measured?  A clear vision about how these things can be achieved will help embed the use of data in decision-making as part of an ICB’s culture.

3. How do we build a sustainable workforce?

The government’s vision is to create a joined up workforce in which health and social care professionals work together in a collaborative and co-ordinated way to deliver services jointly for their local communities. The long term sustainability of the healthcare workforce is clear priority and the white paper – Health and social care integration: joining up care for people, places and populations - sets out the practical steps which will be taken to support the aim of “one workforce” delivering integrated care. 

At a national level, the government has pledged that there will be a review of the regulatory and statutory requirements which currently hinder health and social care staff from working flexibly across the health and care system. We expect to see the introduction of an “Integrated Skills Passport” which will enable staff to transfer their skills and knowledge between the NHS, public health and social care. It is expected that test joint roles in health and social care will be created with these steps expected to ensure that suitably qualified staff are retained in the NHS and wider social care sector. 

At a senior level a national leadership programme is proposed; this will address the skills required to deliver effective system transformation and local partnerships.

There is a focus on the health and wellbeing of all staff across the system, and ensuring that staff are provided with opportunities, training and skills required to undertake their roles effectively. Fostering a culture of inclusiveness and belonging to encourage the long-term sustainability of the healthcare workforce is going to be important. 

4. How do we tackle health inequalities?

The language of health inequalities is changing – the new focus is on “levelling up” and there are now frequent references from government to “health disparities”. Whether this change in language signals a change in approach remains to be seen. However, it is clear that the levelling up agenda is a top priority for government and in particular (as you would expect) the Department for Levelling Up, Communities and Housing (DLUCH).

The recent levelling up white paper Levelling Up the United Kingdom set two targets under the “mission” of improving healthy life expectancy.  These are:

• By 2030, the gap in health life expectancy (HLE) between local areas where it is highest and lowest will have narrowed
• By 2035, HLE will rise by five years

We do not have detailed guidance on steps that ICBs and Places are expected to take to achieve these goals.  However, given the long lead-in times needed to shift these numbers, ICBs and Places should be thinking now about the action they will take. That is likely to involve some data linking and analysis, combined with input from health and care professionals.

The drive to tackle health inequalities should be reflected in the shared outcomes identified by Places for their area.  The recent white paper Joining up care for people, places and populations commits to reigning in national targets – often different for different organisation types – leaving room for Places to choose their own. ICBs will want to ensure that there is consistency of approach across different Places, and that where appropriate Places are sharing learning and resources.

5. How do we achieve sustainability targets?

There is currently focus across the NHS on a range of sustainability measures including an ambitious target to be the first national health service worldwide to reduce its NHS carbon footprint and achieve net carbon zero by 2035. Under the mantle of the Greener NHS programme, all NHS organisations, including ICBs, must support this including appointing someone at Board level to be the net zero / broader green lead. While dates such as 2035 may seem a way off, they will not be achieved overnight and practical steps including analysing the current baseline to understand what needs to be done to achieve net zero as an organisation, need to be taken now.

Conclusions

And so, the key theme for ICBs now, and indeed all working across the system, is don’t stop! While 1 July was undoubtedly an important date it represents the start, rather than the culmination of hard work over recent months by outgoing CCG teams, and incoming ICB leadership, to secure a safe landing. Going forwards much work will need to be undertaken to evolve and adjust to new ways of working, building relationships across the system, understanding what works, and accepting what doesn’t, and make progress towards the wide range of goals that ICBs and their whole systems are being targeted to achieve.