How can Integrated Care Systems (ICSs) cope with pressures this winter?

System and Place leaders will have a challenge this winter. Facing winter pressures from a position of unrelenting summer pressures; high levels of demand for services, dealing with increasing resource challenges (human and otherwise), Covid-19, ICS/ICB establishment & integration, to name a few.

Given the aims of ICSs, the real test will be to juggle the above challenges to deliver on the ‘day’ job (elective recovery, pressures on urgent and emergency care services, the backlog of CHC reviews, winter preparedness etc.). Whilst also maintaining a focus on putting plans and systems in place in collaboration with partners and stakeholders to deliver the long-term transformation the sector desperately needs to enable it to become more proactive. The sector must become better at being proactive to allow it to successfully improve population health and healthcare outcomes or tackle inequalities in outcomes, experience, and access for the populations they serve. The common adage – ‘prevention is better than cure’ seems apt. Effective prevention requires proactivity. However, our health system has historically focused more on the cure.

Given the current cost of living crisis, for example, there are undoubtedly areas of deprivation where individuals are likely to inappropriately seek comfort, warmth and perhaps sustenance from health services or healthcare settings. What long-term measures could be put in place to support these individuals? Loneliness, particularly in the dark winter months, is another cause for unnecessary presentations. How can health and social care systems proactively address these issues? Implementing ICSs will support effective partnership working and resource pooling across social care and health partners. This will require joined-up thinking and good leadership.

The Better Care Fund (BCF) has been an excellent example of how an integrated approach can ensure the best possible outcomes for service users. Arguably, not every organisation understood the benefits of the BCF and those that did, focused on building credible relationships with their health/social care colleagues. It was encouraging to see system partners who had previously been at loggerheads pull down historical barriers to come together in response to the Covid -19 pandemic. We must build on this as we move to more pooled budgets and integrated working.

It is no secret that patient flow is key to addressing many of the sector’s challenges this winter – particularly for health. With a wealth of experience built from working with over 100 organisations (pre-integration) to formulate their winter plans, it is clear what works and what doesn’t. Yet each year, organisations repeat programs that we know will be ineffective. This is often because colleagues and organisations find it challenging to allow the necessary time and resources to focus on scoping out or implementing new innovative ways of working. Effective patient flow is critical to ensuring that ICSs enhance productivity and value for money.

Funding arrangements have always been one of the critical reasons for delays in transfers of care from hospital to community services historically. Systems proved this during Covid with central pooled funding made available for discharge. Given the significance patient flow will play in the effective functioning of the sector, ICS leaders will need to commit sufficient funding to continue the work done during the response to Covid to integrate Acute and Community Services to enable a seamless transfer for patients and their representatives. Discharge to assess, Trusted Assessors, One-off Personal Health Budgets (PHBs/Discharge Grants), and other innovative measures will continue to play a role, particularly as the newly formed ICSs will lack sufficient time to implement radical change in the few months left to winter. However, these will need close management and coordination at the Place and System levels.

 Our experience has taught us that effective patient flow requires dedicated coordination and engagement of all stakeholders, particularly patients, their families, representatives, and community care providers.

The care provider market in the UK is fragmented. It, therefore, requires management and focused engagement. While some systems are doing this with Dynamic Procurement Systems, this can, in time, become transactional. Effective market management is achieved through credible partnerships between providers and commissioners. Social care providers have a significant role in supporting ICSs to achieve their goals, which needs to be acknowledged. It is well documented that the sector is often undervalued and underfunded. System and Place leaders will need to focus on ensuring that care providers across their geography are involved and empowered to enable them to work with the system to plug inevitable gaps that will arise in the future.

Steven Covey talked about putting first things first in his book The Seven Habits Of Highly Effective People. The matrix of importance vs urgency that Stephen Covey used in deciding where to invest efforts is relevant for ICSs to ensure focus is appropriately distributed so that they can become better at being proactive and more responsive to the challenges they will undoubtedly continue to face. It is often too easy to treat every task as urgent and important. Success will come from understanding what needs to be done now, what leaders need to plan for now with long-term aims and ambitions in mind, what needs to be delegated to the third sector & private provider partners or other stakeholders, and what needs to be taken off the list to free up resources for the most urgent/important workstreams.

UB Healthcare is available to help health and social care colleagues navigate their patient flow challenges as we head into winter. We aim to help our health and social care partners deliver innovative, cost-effective, transformational, and value-based services that address their challenges. Therefore, improving outcomes for patients, their families and professionals working within health and social care.

Uko Umotong

Uko Umotong


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