A year of integrated care systems: Berkshire West

The Berkshire West Integrated care system (ICS) footprint spans three local authority areas: West Berkshire (incorporating Newbury), Reading and Wokingham. The ICS covers a population of approximately 530,000, which has little deprivation relative to the rest of the country.

The members of the ICS include Berkshire West CCG, which was established in April 2018 following the formal merger of four CCGs (Wokingham CCG, Newbury and District CCG, South Reading CCG and North and West Reading CCG). The other members of the ICS include acute provider Royal Berkshire NHS Foundation Trust, community and mental health provider Berkshire Healthcare NHS Foundation Trust, and four primary care provider alliances (South Reading Alliance, Wokingham Alliance, Newbury Alliance, and North and West Reading Shadow Alliance).                    

Like Buckinghamshire ICS, Berkshire West ICS sits within the Buckinghamshire, Oxfordshire and Berkshire West (‘BOB’) STP footprint. As such, the Berkshire West ICS is one of the smallest in the first wave of the national ICS programme. While the organisations within Berkshire West remain involved in work on the BOB STP, their focus is on developments at an ICS level.

The ICS in Berkshire West builds on a history of joint working, in particular through the ‘Berkshire West 10’ – an integration programme involving NHS and local authority partners. This programme (which has a wider membership than the ICS) has carried out a number of joint projects, including pooling funding. It continues to run alongside the ICS and the programme’s chair has a place on the ICS leadership team (see below).

ICS structure and governance

The ICS’s governance structure includes a leadership group, comprising the chairs and chief executives of each of the ICS member organisations, led by an independent chair. It also includes the ICS programme director, and the chair of the Berkshire West 10 integration programme who is a local authority chief executive. The leadership group meets every other month and is responsible for setting the ICS’s strategy and monitoring overall progress. 

The ICS structure also includes a unified executive group, comprising chief executives. directors of finance, other senior executives and clinicians from the clinical delivery group (see below). The executive group oversees the operational delivery of the ICS’s work programme and is responsible for monitoring the system’s financial performance. The group meets monthly and is overseen by the leadership group. 

The ICS’s clinical delivery group includes medical and nursing directors from each of the member organisations (acute, mental health and community care), as well as the leaders of the primary care alliances. This group meets monthly, providing clinical leadership for the ICS and shaping plans for changing services. The finance group is made up of the finance directors from each of the constituent organisations and is responsible for the ICS’s transformation funding. The ICS’s programme boards are responsible for delivering the ICS’s work programme. 

The Berkshire West ICS has a dedicated programme management office. This comprises a small number of staff, including a full-time ICS programme manager and full-time administrator, both of whom are funded from the transformation funding allocated to the ICS. It also includes a programme director, who is also the Director of Strategy for Berkshire West CCG (and fully funded by the CCG). 

The governance structure for the Berkshire West ICS is seen very much as a work in progress. The ICS is intending to streamline arrangements over time, and to explore options for bringing the ICS and Berkshire West 10 structures together more formally. 

ICS priorities

The ICS’s strategic priorities for 2018/19 are to:

• develop a resilient urgent care system 

• redesign care pathways to improve patient experience and clinical outcomes, and the best use of clinical and digital resources

• progress a whole-system approach to transforming primary care 

• develop the ICS supporting infrastructure 

• deliver the ICS financial control total. 

Each of these priorities is supported by a number of key projects. For example, as part of its ambition to redesign care pathways, the ICS has made progress in transforming outpatient services, working across physical and mental health services to review activity and capacity.

Stakeholder engagement

The Berkshire West ICS has undertaken a range of steps to engage patients and the public in its work. Each of its project groups includes patient representatives, as well as clinicians, to ensure that both have a role in shaping new care models. For example, patients and the public were engaged in the process of redesigning musculoskeletal (MSK) services. However, as in other areas, engagement in the objectives of the ICS more widely is relatively limited and was flagged by a number of interviewees as an area requiring further focus in future.

Engagement of staff is also an area seen as requiring further work. There is a sense that to date, involvement with the ICS has remained at a relatively senior level within its constituent organisations.

The ICS has attempted to embed Healthwatch within its governance structure by creating an independent liaison post between the ICS and the three local authority Healthwatch officers. It has also established a communications group, responsible for developing an ICS communications and engagement strategy, made up of senior communications representatives from across the member organisations. 

Key enablers

The factors which have supported progress in Berkshire West include:

• the ‘simplicity’ of Berkshire West’s geography, in terms of the number and coterminosity of the organisations included within the ICS

• the longstanding, mature relationships between members of the ICS

• being a relatively high-performing health care economy, with no prior need to focus on managing challenged organisations and where collaboration is seen as a key opportunity for improving performance further.

Next steps

As in other areas, interviewees from Berkshire West identified delivering tangible outcomes against the ICS’s priorities as an important next step, particularly around service changes. This is seen as key in demonstrating the value added by the ICS to staff, patients and the public. Making further progress on funding models was identified as an important enabler in delivering these changes. 

As suggested above, the ICS’s governance structure is seen very much as a work in progress, and the system intends to further streamline arrangements in future. There is also an expectation that, over the longer term, the Berkshire West 10 will become part of the ICS.