Posted on: 24 February 2022
Dear colleagues,
I am writing on behalf of the West Yorkshire Integrated Care System in response to the Health and Social Care Integration White Paper: Joining up care for people, places, and populations.
Overall feedback
The emphasis on close collaboration between councils, public health teams, clinicians, and community organisations, and the opportunity this creates to improve health and wellbeing is something we strongly support.
The white paper complements the direction set out in the new health and care act. I see this as supporting the approach we are taking in West Yorkshire to deliver joined-up health and care for the 2.4million people living across our area. We are also clear that social care and public health investment is critical to any success we achieve together.
We know that fragmentation of governance, finances and regulation can create conflicting priorities and make integration more difficult. We believe that a stronger, shared model of accountability at place level focused on locally agreed outcomes will be an important accelerant to this way of working.
We also know that an overly prescriptive and top-down model of NHS performance management can stifle partnership working, and in some cases act as a source of conflict between local partners. It will be essential that these new arrangements create sufficient ‘space’ for local priorities, based on strong engagement and co-production with local people.
In West Yorkshire we have been working in this way for the past six years, and this has been central to the success of our system. Our model is built on the principle of subsidiarity, where the significant majority of planning and delivery takes place in the five places (Bradford District and Craven; Calderdale, Kirklees, Leeds ,and Wakefield) that make up our integrated care system. We want to retain this model into the future integrated care board (ICB) arrangements, and we expect that the significant majority or resources and functions of our ICB will be delegated to our five ‘place committees’ of the ICB. These place committees will include broad representation from each place, including NHS providers, local authorities, the voluntary community social enterprise sectors, Healthwatch and members of the public. There will be a place-based leader for each of the five places, who will be accountable to the ICB Chief Executive and the place committee.
While getting the structure and governance right is essential, the importance of relationships and collective leadership should not be underestimated. We have worked hard over the years to build collective leadership where political, managerial, professional; clinical and community leaders can make real change. Our model of distributed leadership means that all health and care leaders across West Yorkshire take an active leadership role in West Yorkshire priorities. This has helped to build a sense of ‘us and us’ and build a wider West Yorkshire leadership team.
We have also adapted the Local Government model of peer review and applied it to our places. This has enabled the sharing of learning and helped to strengthen empathy and trust across our leaders.
Government recognition of the importance of integration with housing is helpful. We are already working in our local places to do that through health and homelessness prevention programmes and through investment in extra care and supported housing.
The future of integrated care systems requires us all, not just the NHS, to develop new ways of working – ones which are transparent and makes better use of sharing insight and data to improve people’s care – from preventing ill health right through to hospital and community care. Eight sites in West Yorkshire are using remote monitoring technology to enable virtual wards for patients and for those in care homes. These allow patients to monitor their conditions at home and care workers to monitor residents within care homes, with results going directly to their clinician who can then arrange appropriate contact and treatment. We are reaching out to wider partners seeing this work in practice, for example in good housing for health, our winter warmth initiative, which is led by public health insight, and investing in retention of independent care sector worker with councils and the development of becoming a trauma informed resilient system, with the West Yorkshire Violence Reduction Unit.
Other considerations
These developments are being considered in the context of the pandemic, pressure on national and local authority budgets and substantial inequalities, set out in the recent Northern Health Science Alliance Reports.
They also appear at a time when the Messenger review is considering leadership in the health and care system; a review of the NHS Operating Model is being undertaken; and Professor Sir Chris Ham’s report on Governing the Health and Care System in England has made sensible recommendations. This white paper can be successful if it continues to be part of a coherent whole.
Perhaps the biggest gap in the policy firmament is the workforce plan for health and care. Alongside the widely understood gaps in the NHS, a longer-term solution is needed to ensure our social care workforce feels suitably recognised and valued financially and in terms of the status of their work. We hope that this appears in time to help make this white paper, and the improvement in outcomes for local people, a reality.
Conclusion
The white paper brings further coherence to the Government’s policies on integration. It must be considered alongside the social care and levelling up white papers, and the forthcoming Health and Care Act and continuous scrutiny of the overall whole is required.
By focusing on shared outcomes, system regulation, system incentives, shared leadership, data, and our people, this white paper starts to create the conditions for success. This shift in emphasis is necessary if we are to meet people’s mental, physical, and social needs in the future and have a chance to deliver recovery of the elective backlog.
We also welcome the recognition that places, and populations have differing needs. Maintaining flexibility of local arrangements within a clear set of national outcomes and standards gives the right balance for operating within a local context.
Your sincerely,
Rob Webster CBE
West Yorkshire Integrated Care System CEO-Designate