In my experience, the leaders most closely involved in STPs and ICSs are usually positive about the opportunity to work in partnership with others, even if the Health and Social Care Act 2012 does not make this easy. Other leaders, and particularly staff delivering care to patients, are more sceptical, aware of the time-consuming nature of the work involved and impatient to see results. ‘What has the STP/ICS ever done for me?’ is a question I hear staff ask increasingly often, and it requires a credible answer to ensure that the momentum that has been created is not lost.
Our work at the Fund shows that the ambitions outlined in the plans prepared in 2016 are being delivered by STPs and ICSs in neighbourhoods, places and systems.
Work in neighbourhoods is integrating a range of services around populations of between 30,000 and 50,000. These services typically include general practices, community teams, some mental health services and adult social care. Developments in neighbourhoods are often based on the work of the new care models and primary care home projects with the aim of understanding the needs of the populations served and intervening early to meet these needs.
Work in places builds on progress in neighbourhoods to forge stronger links between acute hospitals and other providers. Greater Manchester works through 10 places and South Yorkshire and Bassetlaw through five, each place serving an identifiable community such as Bolton or Barnsley. These are often places where local authorities have a track record of working as community leaders and have created partnerships with the NHS and others. Placed-based working provides an opportunity to promote health and wellbeing as well as to integrate a range of health and care services, exemplified by the work of the Healthy Wigan Partnership.
Systems exist to deliver what cannot be achieved in neighbourhoods and places. An obvious example is to provide leadership on service reconfigurations that cut across different places, as in work underway in Dorset and South Yorkshire and Bassetlaw. Some STPs and ICSs are finding that they need to work with neighbouring systems to plan and deliver these reconfigurations. Systems also have a role in tackling issues such as the workforce, the use of the estate, and IT where it makes sense to adopt a common approach across places. In all of this work, systems are seeking to improve and transform care and national bodies are looking to them to play a bigger part in managing performance and resources.
The most advanced ICSs are beginning to take ownership of serious challenges that previously would have been addressed through external intervention. An example from Greater Manchester is the way in which Salford Royal and Manchester University NHS Foundation Trust are providing support to Pennine Acute Hospitals NHS Trust after the Care Quality Commission rated the trust as inadequate. Support is being overseen by the Greater Manchester Improvement Board with involvement of both commissioners and regulators. There are signs that this approach is producing benefits with the trust being reassessed recently as requires improvement.
ICSs like Frimley are demonstrating that a sustained commitment to work in neighbourhoods, places and the wider system is delivering measurable results. Andrew Morris, who leads the Frimley system, has spoken of the impact on its hospitals of work to improve services in the community as long-term increases in demand for hospital care are being moderated and in some cases reduced. This has been achieved by improving patients’ access to general practice, developing neighbourhood hubs to integrate out-of-hospital care, providing alternative forms of care and support for people with mental health needs, and changing the way in which hospitals work, for example, by senior doctors seeing and treating patients in A&E to enable them to be discharged where appropriate. Parts of the ICSs in Nottinghamshire and Nottingham and Surrey Heartlands are reporting a similar impact.
STPs and ICSs are, of course, at various stages of development and many have much work to do to persuade the sceptics that they will deliver benefits for staff and patients. Realistically, it will take time for every area to move from planning to implementation, particularly when the operational pressures facing the NHS mean that organisations are understandably focusing on their own challenges rather than system-wide issues. Legislative and regulatory barriers also create obstacles that will need to be removed when the government decides that the time is right to amend the Health and Social Care Act 2012 to bring its provisions into line with what is now being expected of commissioners and providers.
Ultimately, the fate of STPs and ICSs will depend on the willingness of organisations and their leaders to commit to partnership working and to see it as the best hope for enabling the NHS, local authorities and others to transform health and care for their populations. Areas that are making progress are doing so despite the statutory framework and because their leaders have invested in developing collaborative relationships to support their ambitions. Other areas should learn from this experience and their leaders and staff should be asking themselves ‘What can I do to ensure that the STP/ICS succeeds?’ and not ‘What has the STP/ICS ever done for me?’