A reorganisation of the NHS is happening across the country and the keystone element is the formation of Integrated Care Systems. For the public, this will likely be seen as another remote, confusingly named initiative, but nevertheless NHS leaders see this as their big idea for improving the planning and delivery of healthcare.
Built around the concept of integration it means more than stronger partnerships between health and are care professionals and organisations. It involves a shake-up of all the current structures – the merging of local commissioners (CCG) into larger bodies is well underway, but it also raises serious questions about who will run the service, how will it be funded, will it be comprehensive and who is accountable?
We are running a series of articles and reports to help monitor and analyse what’s happening and below is our survey of the ICS websites – which shows some areas are moving faster than others.
Our quick review of ICS websites:
Although it has some recent, general, press releases, and a Covid blog, the website of this early ICS shows that the Collaborative Board has not met since October 2019. The ICS performance link is to a 2017 NHS England Dashboard.
This ICS website has recent press releases on general topics but no reference to partnership board or ICS level decision making. The most recent newsletter boasts a message from Andrew Lloyd, Chair of the Frimley Health and Care ICS Board which begins “As we approach Christmas and the New Year”.
No apparent “Latest News” on this website since January, when the main focus was on celebrating the decision of the Independent Reconfiguration Panel to overrule objections from local campaigners and rubber stamp the downgrading of Poole Hospital’s A&E to focus all emergency services in the south of the county in Bournemouth.
This was an early ICS, but its bland Partnership Board papers from March 2020 give no sign of anything happening other than vague discussions. “Bimonthly” ICS Briefing not published since July 2019 – long before Covid-19 could be used as an excuse.
This appears to be the most serious of the ICS websites, with a monthly schedule of meetings up to March that appear to include some detailed financial reports in their papers (along with many pages of much more general and unfocused material that appear to simply restate the obvious in more complicated ways).
The website makes clear that while “The role of the Integrated Care System (ICS) Board is to provide leadership and development of an overarching strategy for Lancashire and South Cumbria, oversight and facilitation of the delivery of sustainability, transformation and design of the future state of health and care,”
“The ICS Board does not meet in public and the papers are not publically available, at this time. However the ICS Board will review this again in 2020.” Tucked away is an admission of a £200m funding gap for 2019/20.
An annoying website with lots of sliding and zooming panels is still promoting a September 2019 response to the NHS Long Term Plan and a January 2020 “engagement report” which lists, rather than responding to, public views on plans for a single CCG to cover the ICS area. The website and a governance chart appear to show this ICS has not even the pretence of a Partnership Board, and relies on “a lean and agile BOB ICS operational team”.
The Meetings and Events page simply states “Sorry there are no meetings or events”. It appears that there was a meeting in January, although little of any consequence is revealed from the Agenda, with no papers attached: the most recent minutes are from October 2019. A resources page has a range of videos on coronavirus and other topics.
‘News’ on this largely empty website runs up to May 12 2020, but there is no information on any partnership or other board structure or any meetings or board papers – in public or otherwise.
The Strategy statement promises: “We recognise our strategy will be constantly evolving and intend to update this document in autumn 2019 following submission of our five year plan to NHS England (which details how we will be implementing the NHS Long-Term Plan).”
This ICS is one of TWO ICSs covering the Epsom & St Helier hospital Trust, which serves the population of the former Surrey Downs CCG, and is engaged in their own plan for a new £500m acute hospital in Sutton that would almost halve numbers of acute hospital beds, and be much less accessible for Surrey residents.
A relatively lively site which links in to Gloucestershire County Council has up to date news and press releases, mainly on social care, and no info on the work of the ICS.
This website is one of the few with visible evidence that the ICS Health and Care Partnership Board is functioning, although recent meetings are understandably focused on Covid, and the looking forward document is predictably vague. It has a dauntingly huge list of Priorities, and some recent blogs: but its Next Steps document dates back to 2018!
This ICS has taken the street name of “Can Do Health and Care,” although it appears it hasn’t done any Board meetings since April 2019, and its most recent News Update was last October. Resources include some generalities on the ICS, and a ‘Winter 2018/19 Communications Toolkit’.
The March 2020 Board Agenda and Papers noted that most of Objective 10 (Deliver improvements and innovations for elective care) was “off track” – but contained no finance report.
Only a limited website so far for this new ICS covering Croydon, Kingston, Merton, Richmond, Sutton and Wandsworth, and offering a link to its 2016 Sustainability & Transformation Plan, which declares:
“South West London STP will continue to need all of the hospitals it currently has, but does not believe that every hospital has to provide every service. … The immediate focus is on getting primary care and services in the community right.”
However this ICS is one of TWO ICSs covering the Epsom & St Helier hospital trust, which is engaged in a separate plan for a new £500m acute hospital in Sutton that would downgrade Epsom & St Helier hospitals, almost halving numbers of acute hospital beds, and cause knock-on impact in neighbouring SW London hospitals, especially St George’s and Croydon .
A huge banner instruction to ‘Stay Alert’ as you land on this ICS website is not backed up with much an alert person can do, or any information on Partnership Board or equivalent meetings, papers or discussions.
The Upcoming Events slot is equally unhelpful, with no past or future content.
It’s not clear whether anything is happening behind the scenes, but obvious nothing is being done in public view.
The most recent Programme Board papers relate to early 2018 STP meetings.
The NHS England link is to the largely defunct old STP website: a search for Hertfordshire and West Essex ICS takes us to a website that reports the STP has been given ‘Integrated Care System’ status.
However the ‘STP System Leadership Arrangements’ give no indication of plans for any Board to be established, let alone Board meetings in public or board papers published.
The website no mention of seeking public involvement or consultation.
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