What is an Integrated Care System (ICS)?

The Next Steps on the Five Year Forward View signalled a new approach to integrating care locally, referred to as ‘integrated care systems’. An ICS will be the most developed version of a sustainability and Transformation Partnership (STP).  It will be given greater autonomy and financial backing from the centre in return for taking greater responsibility for delivery and finances across the patch.

How many integrated care systems are they?

We are only one of four partnerships to join wave two. This is national recognition for the way our WY&H partnership works - it means we can join the cutting edge of health and care policy, gaining more influence and more control over the way we deliver services and support for the 2.6 million people living across our area.

This was announced on the 24 May 2018.

You can read NHS England and NHS Improvement Board Meetings in Common – agenda and papers from the 24 May 2018 here for more information.

A first wave of eight shadow ICS was announced by NHS England and NHS Improvement in June 2017. They were placed into a development programme, along with the two health devolution areas (Greater Manchester and Surrey Downs). This brings a total of 12 out of 44 ICSs across the country.

What was the process?

NHS England and NHS Improvement invited West Yorkshire and Harrogate to submit an expression of interest to join the second wave of the ICS development programme. Local leaders agreed to proceed and we submitted our expression of interest in February 2018.

We heard in May 2018, in an announcement made by Simon Stevens, CEO for NHS England that we have been successful and will be joining the ICS development programme in shadow form immediately. Shadow form means we are preparing to become a formal integrated care system.

What benefits does being an ICS bring?

An ICS is a partnership that is given flexibility and freedoms in return for taking responsibility for the delivery of high quality services now and in the future. It brings together some elements of NHS regulatory functions with health and care commissioning and service provision.

With these new governance and accountability arrangements in place, our partnership would be able to take on greater responsibility for:

  • The planning and design of the change programmes that need to be driven once across West Yorkshire and Harrogate and overseeing delivery locally
  • Managing transformation funding and capital; and oversight and delivery of milestones set out in the WY&H plan.

Who made the decision to join the programme?

WY&H Health and Care Partnership leadership team discussed the benefits of securing greater autonomy and control over resources, including money, from national bodies that an ICS would bring to the area. Joining the development programme is a natural progression for our partnership and allows us to take on these responsibilities at a time that is right for us. It sits with our ethos of being ambitious for the people we serve and demonstrates our commitment to improving health and care for everyone.

As a network of leaders running the second biggest partnership in the country (2.6 million people, £5 billion budget), we feel we have the leadership needed as well as the opportunity to contribute significantly to this way of working. It will also mean we receive a fair share of new national resources to deploy locally, rather than having to bid for money in small lots.

Our Partnership is made up of over twenty organisations, including Healthwatch, care providers and community organisations. Working with and for communities is also a priority to us. You can see a list of some of our partners here

What does this mean for local places (Bradford District and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield)?

Each of our local places is working through how they will work together more closely to further develop their partnership approach. It’s clear that our local places will have different plans and what is right for one may not be for another. In line with our WY&H plan, (a public summary is available here) all decisions on services need to be made locally as close to people as possible. Our move to becoming an ICS is predicated on this continuing to be the case.

The WY&H ICS will therefore focus on the work that can only be done at this level i.e. the nine programmes, for example cancer, mental health, stroke, urgent and emergency care.

Why now?

Since the creation of West Yorkshire and Harrogate Health and Care Partnership in March 2016, the way we work has been further strengthened by a shared commitment to deliver the best health and care outcomes possible for the 2.6million people living across our area. Our commitment remains the same and our goal is simple, we want everyone in West Yorkshire and Harrogate to have a great start in life, and the support they need to stay healthy and live longer. We are committed to tackling health inequalities and to improving the lives of the poorest the fastest. This is a natural extension of the way we have been working across the area and is a strong endorsement of the progress we are making.

Why is working in this way important?

The importance of joining up services for people at a local level in Bradford District and Craven; Calderdale; Harrogate and Rural District; Kirklees; Leeds; and Wakefield is at the heart of our local plans and our WY&H programmes. All decisions on services are made as locally and as close to people as possible. Our move to becoming an ICS is predicated on this continuing to be the case. 

This integrated approach to health and care continues much closer working between our organisations, rather than traditional, top down approaches based on mergers or the creation of a new organisation. This demonstrates our distributed model of leadership and focus on prevention, wellbeing, communities, primary care, mental health, acute services and world class innovation is being supported. 

This recognition allows us to continue strengthening our partnership. It also means we can begin to develop the formal delegation of money and resources to WY&H over the coming year. This is very important to us.

What does this mean for communities?

Joining up health and care will improve the health and wellbeing of our communities. New ways of working will improve care we offer to people – integrated teams are good news. The Partnership are working together in a much more joined up way than ever before.

We have good working relationships and shared goals across our local areas and wider WY&H work. This is the way the NHS will consider funding in future and we know this is important to secure investment across WY&H to improve health outcomes and prevent ill health.

The ambitious proposals set out in our plan are firming up into specific actions, backed by investments. This is being done with the help of our staff and communities, alongside their representatives, including voluntary, community organisations and local councillors. Our bottom up approach means that this is happening at both a local and WY&H level, which puts people, not organisations, at the heart of everything we do.

What is the Memorandum of Understanding?

Part of strengthening our approach is the development of a MoU. This will be an agreement between the WY&H health and care partners, setting out the details of our commitment to work together in partnership to realise our shared ambitions. The MoU does not introduce new hierarchical arrangements. Rather, it builds on our current ways of working and will provide a new model of mutual accountability to underpin collective ownership of delivery.

This is different to be being an ICS.

The MoU is expected to commit the NHS organisations in the West Yorkshire and Harrogate Health and Care Partnership to move towards collective oversight of the region’s annual £5bn healthcare budget. It is important to note that these arrangements are still in development so nothing has been agreed at this stage. It will only be finalised once partners have agreed.

Why does the name keep changing?

Over the past 18 months there has been considerable focus nationally on terminology for this way of working with various names being used, for example ‘sustainability transformation partnerships (STPs)’ and more recently ‘accountable care systems/organisations/integrated care systems’. Some of the terms are close to those used by the system in the USA, which has led to suggestions of privatisation and insurance style models. This is incorrect.

We remain clear that we are working towards greater autonomy and more flexibility in the way we manage so we can further develop and deliver high quality health care services now and in the future. This means national labels like being an integrated care system may be applied, but what we actually want to achieve is far more than a name. We are proud to remain the West Yorkshire and Harrogate Health and Care Partnership.

Are you privatising the NHS?

There is absolutely no intention to move healthcare away from being entirely publically funded. What we really want is to make ways of working for staff much easier – something that we have heard loud and clear, more local control and freedom to make decisions for people and additional funding to support our plans, at both a local place level and across our West Yorkshire and Harrogate priorities. So we have the whole system working for the whole system with one budget and so people don’t have to repeat their story over and over again.

The main participants involved in developing integrated care are NHS organisations and partners in the public sector and they are making progress by collaborating not competing.

What will it look and feel like?

What we hope people will see over the coming months is evidence of the trust and collective leadership across our partnership so that together we can effectively support many more people in their homes, whilst reducing hospital demand and fully supporting GP practices and community services so they are able to become the first point of contact for health no matter what time of day.

We want to further develop services to help people stay well, whilst delivering more care in the community, so together we free up specialist hospital care to concentrate on what only they can do. 

Considerable effort and commitment from many partners has helped us to get to this point and we are now in an even stronger position to move forward together as one health care system.

It will also mean we have a simplified and streamlined set of relationships with national bodies, i.e. NHS England (NHS E) and NHS Improvement (NHS 1) so that our partnership working becomes easier. To help us achieve this NHSE and NHSI have provided us with staff to support our journey to become an integrated care system in shadow format.

What about commissioning?

We have strengthened our joint commissioning across West Yorkshire and Harrogate through the creation of a joint committee of CCGs, which has delegated authority for collective decision making from the nine CCGs in the partnership. In each place, collaborative commissioning between CCGs and local government continues to strengthen, so that we commission care that is more joined up. You can find out more about Joint Committee here.

What next?

Following our principles of openness and transparency we are continuing to have conversations with partnership employees and stakeholders, including local people and their representatives i.e. MPs, councillors, members of the West Yorkshire Joint Health Overview Scrutiny Committee, local Health Overview Scrutiny Committees and Health and Wellbeing Boards, we will continue to work together as we develop our integrated approach.

What about the voluntary and community sector? (VCS)

We already work closely with Healthwatch and many community organisations. We aim to achieve closer partnership working with shared objectives in each of the six local places (Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield) and across the WY&H programme priorities. This includes health and care partners, including VCS, housing and employment services working together. Some of our local places have memorandums of understanding to help formalise this way of working and many, if not all, are working very closely with the VCS already. And also lots of care providers.

What about our workforce?

West Yorkshire and Harrogate Health and Care Partnership will publish their workforce plan ‘A healthy place to live, a great place to work’ in June 2018.

The publication describes how the health and social care workforce of over 100,000 in West Yorkshire and Harrogate is changing to meet the current and future needs of the 2.6 million people living across the area.

Reshaping healthcare requires a reshaping of the health and care workforce. New teams are emerging with an increased role for non-medical staff to work alongside medical staff; non-registered staff to work alongside registered professionals and new roles alongside traditional ones.

There are over 260,000 carers in WY&H, what are you doing for them?

The Workforce Plan also recognises the huge contribution community organisations and volunteers make; and the vital role of the 260,000 unpaid carers who care for family and friends day in day out and whose numbers are more than that of the paid workforce. Supporting working carers is also an important partnership priority. You can read more about our approach to improve the support for unpaid carers in West Yorkshire and Harrogate here.

This means at all levels the Partnership is:

  • Working to improve people’s health with and for them
  • Working to improve people’s experience of health and care
  • Making every penny in the pound count to offer best value to the taxpayer.