Integrated care systems aren't provider-based organisations; although
providers are key partners they are planning mechanisms to try and make
sense of that complexity and fragmentation within the organisational
landscape, but within them at least within the larger and more complex ones
there are integrated care partnerships which are very much about how care is
provided; so alliances of NHS providers working together agreeing to collaborate
rather than compete, and including in their most advanced development,
hospitals, community services, mental health, GPS and social care, and
independent and third sector providers. 80% also will get delivered at a
place-based partnership level in places like Sheffield and Doncaster and
Barnsley and Wigan and Bolton and Trafford to give you those examples with
20% perhaps being led at a system level. There is no manual, there is no guidebook
that says this is what an integrated care system is this is how it should be
organised and this is what it should do. The colleagues involved in the 10
integrated care systems are themselves writing the manual on system working; you
have the larger ICSs Greater Manchester not far short of 3 million
South Yorkshire Bassetlaw 1.6 million large complex and the way I've been
describing at the other extreme we've got Blackpool about 300 thousand you've
got many of the ICSs around about half 3/4 of a million size and there is a
kind of emerging bubbling debate about well can it be right that we have so
much variation in size and complexity in the cohort in this first wave of ICSs and
is there any move at all to begin to bring together the smaller ones to make
them more like the bigger ones. I think there's an obvious rationale for doing
that but there are some big risks potentially as well, given the importance
of the relationships within the systems partnerships and the risk of putting
those on one side for the sake of neatness around some kind of
organisational map what are the emerging functions and roles of integrated care
systems well the way we've seen it is there's a
planning function building on what the STPs have set up it's about how you then
can align but not do the commissioning behind the plan it's about bringing
together over time the functions of NHS E and I alongside the integrated care
system putting it bluntly the worst of all outcomes would be to add another
layer of complexity called an integrated care system to the already too many
layers of complexity we have in the fragmented complex complex legacy of the
2012 Act it's about taking responsibility of the system level that
overseeing performance in the system self-evidently it needs to be about the
provision of system leadership on the issues that require system leadership
and owning and resolving system challenges rather than looking
externally for help from them management consultants or from the turnaround
specialists or from others this is all about collective leadership across the
organisations and distributed leadership from the top to the bottom and the
staffing of integrated care systems is developing through changes to the roles
of CCGs the roles of regulators and through secondments from partner
organisations. Greater Manchester has within it 10 integrated care
partnerships to use my language they call them local care organisations based
around the boroughs and the City of Manchester building the links between
the hospital for community services, GPs and local government and they're doing
fantastic work in some parts of Greater Manchester I'll highlight particularly
the work I had the opportunity to visit with colleagues in Wigan to reach into
their community and work with community organisations than the wider range of
community assets in looking at the wider determinants
working across different sectors to address them so a lot of green shoots
appearing but the under no illusions all of the ten areas face exactly the same
operational pressures and stresses and strains certainly through the winter as
the rest of the NHS and why should we expect it to be any different when ICSs
haven't even celebrated their first birthday with the exception of the
Greater Manchester so I hope I've been moderately positive in my comments so
far but let's recognise the reality the harsh reality of the challenges in doing
this work regulators have been in my view far too slow to align their work in
the right way behind integrated care systems and that continues to be a
problem I worry about the demands were placing on our leaders who have their
organisational roles their ICS roles their partnership roles and so much more
besides local authority involvement has been really positive in many places but
not everywhere and we've got work to do to tackle that the concerns about is
this really to do with privatisation and the to judicial review challenges have
raised concerns in some quarters that have not been particularly helpful and
integrated care systems have started to deliver but we need to see more of that
to reassure those who aren't naturally supportive of the ICS system based
working