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E-scooters at a crossroads
E-scooters at a crossroads

Posts Tagged ‘Integrated Care Systems’

What are the learnings so far at Integrated Care System (ICS) level to reduce health inequalities?

In conversation with NHS Gloucestershire Integrated Care Board (ICB)

The need for local community action to address health inequalities has never been greater. Over the last few months, we’ve seen a disbanding of the Office of Health Inequalities and Disparities (OHID), the government department set up to drive a meaningful step change in health inequalities.

However, with disappointment comes opportunity.

In a year of political change, many are looking to ICSs who have a statutory duty to reduce health inequalities, as the engines of meaningful progress. Now almost two years on since their formal legislation, each ICS is taking a different approach in response to addressing health inequalities, with great success.

We sat down with Becca Smith, Associate Director Clinical Programmes, Frances Beavis, Senior Project Manager and Natalia Bartolome Diez, Insights Manager EDI to talk about their tailored approach to working with people and communities, and why they are confident it is already working.

What are you doing differently to understand the nuances of the diverse community you work with?

Everything starts with building trust. Whilst national health campaigns over the years have had great results in shifting behaviour, it is the underserved populations that are often forgotten. There are multiple reasons for this, too many to get into today, but one of the most important factors is a lack of trust in the health system. We decided to create a new role, an ‘Insights Manager’ to act as the point of reference for many different religious, ethnic and social-economic communities into the NHS to work out how to overcome this. Our Insights Manager’s main role is to listen and to truly hear the needs of seldom heard communities. Doing this allows us to truly understand what we need to do differently, what are the simple fixes and what are the longer-term changes that will get the results these groups deserve. All good plans start without assumption, and we are seeing the benefits of this first hand.

And more broadly, how does addressing health inequalities fit within your wider organisation?

Often within an ICB, there is a dedicated health inequalities team. However, responsibility for health inequalities is also shared by team members across the organisation, including team members in specific disease areas −transformation roles as well as clinical leads may share responsibility.

If you are interested in collaborating with an ICB on a health inequality initiative, we would recommend mapping stakeholders via desk research. You should also be prepared to speak with several people within the ICB to identify the right person with responsibility for your area of interest.

Is it time to stop categorising ‘ethnic minorities’ into a catch all definition?

We have seen that there is real benefit in developing engagement strategies that are tailored to specific ethnic groups. There are different social and cultural norms between different groups and with this, different barriers and drivers. There can be a tendency to develop health engagement strategies for all ethnic minority communities but increasingly as a sector, we are understanding that engagement needs to be more specific. What might work for one community may not work for another.

Do you have any projects that show this new approach is succeeding?

There are a few examples that we are incredibly proud of.

Our collaboration with the Gloucester Health and Care Community Cancer team to host an early diagnosis in prostate cancer event for Black men demonstrated how local community events are starting to inform local policymaking.

Firstly, we made sure that the prostate cancer event was hosted in a local, familiar space that Black men attended regularly – in this case the local community centre. We also invited a range of people including doctors, clinical nurse specialists, support workers and a Black man with lived experience to provide information on the symptoms of prostate cancer, treatment options and support options.

During the event, attendees suggested some helpful screening recommendations, including offering a drop-in clinic at the community centre for prostate-specific antigen (PSA) testing. This will be discussed with Gloucester ICB’s Cancer Patient Reference Group, a group of people affected by cancer that inform the strategy and activity of the ICB.

We also worked with the Gloucester South Asian local community centre over the course of a year to explore barriers to NHS England’s digital diabetes platform, which sets out to help people manage their diabetes. We managed to identify specific language barriers and develop solutions to inform a national pilot programme.

It’s great to see these new approaches achieving high engagement from communities and now feeding in to how we shape our services in long-term chronic conditions.

If you are interested in further examples of local best practice or how to work collaboratively with an ICB, contact Rose Brade at rosebrade@wacomms.co.uk or Clara McDermott Simarro at claramcdermottsimarro@wacomms.co.uk.

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Addressing England’s cardiovascular disease emergency – learnings from the new ICS five-year plans

England’s Integrated Care Systems (ICSs) have published their five-year joint forward plans, setting out Integrated Care Boards (ICB)-led priorities to tackle physical and mental health challenges being faced in their populations. We are summarising the key priorities of ICS’s in a series of articles, based on data revealed in our interactive map. This map is free to use, supporting better engagement and collaboration with all stakeholders in the healthcare community – industry, patient organisations, and the NHS.

Here, we focus on ICS five-year plans tackling cardiovascular disease (CVD).

Cardiovascular disease continues to be a top priority

Cardiovascular disease (CVD) is the top priority in almost two-thirds of ICS plans, second only to cancer, and every ICS has identified it as one of their top priority clinical areas. And rightly so. CVD affects around 7.6 million people in the UK and is a significant cause of disability and death. Since the beginning of the COVID-19 pandemic, CVD-related excess deaths have spiralled and although we are seeing signs of recovery year on year – the number of deaths involving CVD has remained higher than expected.

So, what are the key approaches being taken to tackle CVD across the nation for the next 5 years? Prevention, targeting inequalities, moving care into the community, identifying risk, and using digital technologies.

Prevention. Every ICS emphasised the importance of CVD prevention. Most plans pledge to tackle modifiable risk factors such as smoking, alcohol, and inactivity. Case example: The Humber and Yorkshire ICB CVD Prevention and Detection Plan 2022-24 covers primary, secondary, and tertiary prevention tactics for CVD, in addition to proposed methods for risk stratification and early identification.

Targeting inequalities. People living in England’s most deprived areas are almost four times more likely to die prematurely of CVD than those in the least deprived areas. So it’s reassuring to see Core20PLUS5 features in every plan and that many ICS plans are tailoring community interventions to help those most deprived. Case example: Dudley is launching a mobile Healthy Hearts Hub to empower residents to manage their own CVD health and will be moving throughout the area to reach the most deprived communities.

Community services. Many ICSs propose to increase care in the community for people with CVD, reducing demand on hospitals and reaching more patients. Some plan to achieve this through Community Pharmacies and Neighbourhood teams, others through digital engagement. Case example: Black Country is expanding community pharmacy blood pressure services and further embedding personalised care at that level through Health and Wellbeing Coaches as part of the Healthy Hearts Project.

Identifying risk. Optimal management of cross-cutting risk factors like high blood pressure and high lipids, to prevent CVD, or diagnose and treat people earlier. In many ICBs, cardiac pathway reforms are being proposed to enable this shift. Case example: Suffolk and Northeast Essex is encouraging the use of Accelerated Access Collaborative pathways to simplify lipid management and encourage adherence to national guidance for optimal management of patients at high risk of CVD.

Digital technologies. Many plans emphasise the monitoring, treatment, and detection of patients with CVD-related conditions, tying into the imperative around community care. This is tied to a much broader drive to scale tech innovation in the NHS whereby each ICB has laid out an extensive digital strategy. Case example: Mid and South Essex is continuing with the successful national pilot BP@home, where residents are self-monitoring blood pressure; they are also rolling out mobile heart monitors allowing people to detect, monitor and manage heart arrhythmias.

What does this mean for industry?

We hope you found this useful – if you would like to discuss in more detail, please get in touch.

Further reading:

Five key takeaways: Engaging with ICS priorities panel session https://wacomms.co.uk/five-key-takeaways-engaging-with-ics-priorities-panel-session/

Engaging with Integrated Care Systems priorities https://wacomms.co.uk/engaging-with-integrated-care-systems-priorities/

What the new integrated care model means for specialised services https://wacomms.co.uk/what-the-new-integrated-care-model-means-for-specialised-services/

 

About WA Communications

WA Communications is an integrated strategic communications and public affairs consultancy. Our specialist health practice supports clients across a diverse range of diseases at the intersection of policy, government affairs and communications, to achieve their strategic objectives.

If you would like to discuss how to best work in partnership with Integrated Care Systems, and our analysis of their key areas of focus, contact Lloyd Tingley at  lloydtingley@wacomms.co.uk.

 

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The Hewitt Review unpacked

In July 2022, Integrated Care Systems (ICSs) were formally established with the intention of delivering joined-up services along a place-based approach, improve outcomes in population health and tackle health inequalities across the country. 

Yet, just six months into their formation, Chancellor Jeremy Hunt announced a review to be undertaken by Patricia Hewitt, former Secretary of State for Health and current chair of Norfolk and Waveney Integrated Care Board.  

The review sought to consider the oversight and governance of ICSs, examining the balance between greater autonomy and accountability for these emerging structures.  

Hewitt’s paper, published yesterday, reiterates the significant potential of the new NHS structures to deliver more strategic and sustainable healthcare – albeit with refinements. However, with a muted response from the DHSC and NHS England on timelines for responding to the review’s findings, there are questions over whether core recommendations will be taken onboard with any sense of urgency. 

What stood out? 

Prevention and population health 

The review reiterates the big opportunity of prevention and proactive population health as key to sustainable solutions to immediate performance pressures in the NHS. This is a well-trodden message – but one that continues to be easier to write about than deliver.  

To address this gap, Hewitt argues for a change in how the health and care system operates. This includes a shift in resources, to which she recommends a 1% increase in the NHS budgets going towards prevention. She also calls for a Government-led national mission on health improvement, with prevention, the reduction of health inequalities and the social determinants of health as musts, rather than ‘nice to haves.’ 

This sentiment is in keeping with other recent policy reports on prevention and early intervention, such as the recent Health and Social Care Committee inquiry into prevention which received over 600 stakeholder responses.  

Largely missing was any focus on industry partnership beyond high level commentary on evolving pathways and vendor management. This suggests that treatments are still not seen as a key part of the approach towards better population health.  

The potential of delivering on placed-based priority and need 

A big theme in the review is the need for a shift from a top-down, centralised system of managing the NHS to a bottom-up system, responsive and responsible to local communities.  

To facilitate this, Hewitt recommends a reduction in national targets with no more than 10 national priorities and the development of ‘High Accountability and Responsibility Partnerships’ (HARPs). These are additional mechanisms aimed at incentivising integration across all partners of a local system.  

However, integration and true place-based care cannot be fully achieved without local government and social care involvement. This has already been somewhat muted with the decision to create two local bodies – healthcare-led Integrated Care Boards and wider community involvement through the Integrated Care Partnerships. And there is an irony that on the same day as Hewitt review was published calling for better integration of health and social care, a £250m of budget committed to support social care innovation and training was withdrawn. Without a genuine joined-up approach, the opportunity for integration is unlikely to be truly realised.  

Decisions on accountability and governance  

Fundamentally, the review was commissioned to consider the oversight and governance of ICSs. However, it is not immediately clear whether this question has been answered and the critical question of whether ICBs or NHS England manages Trusts has been fudged.  

The review recommends that any intervention from NHS England direct to Trusts should come through the ICB structures. However, it then peddles back on that ambition by stating that it needs to be proportionate to the strength of the relationships, leadership and challenges facing a local system. 

Therefore, there is still considerable room for NHS England to be involved in the performance of local care providers. This takes away from the intended freedoms and flexibility at the forefront of the ICS model. 

Better funding flows 

The review does not call for any additional funding for NHS services but rather scratches beneath the surface to offer a remedy for how operationally government spending on health can achieve value for money.  

Hewitt identifies “over-complex, uncoordinated funding systems” as an impediment to achieving this principle. She calls for ICS funding to “be largely multi-year and recurrent” and for budgets across health and local government to be better aligned.  

Greater financial autonomy as well as simplified and coordinated funding behind ICSs has been welcomed as a recommendation. However, the varying degree of maturity of ICSs across the country, as recognised in the review, risks investors needing to adopt a more cumbersome and tailored approach depending on the ICS. 

What’s next? 

As yet, next steps remain unclear. The Government will respond to the central recommendations, but not immediately. Clarity around responsibility and accountability between NHS bodies may take more time. Many other key points may be chalked up as ‘requiring further consideration’. 

Jeremy Hunt – who commissioned the review – retains his interest in health improvement and is keen to drive better outcomes and efficiencies for patients and the public purse. How far he is prepared to loosen the grip on NHS budgets remains to be seen.  

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