A year of integrated care systems: Lancashire and South Cumbria

The Lancashire and South Cumbria integrated care system (ICS) covers five integrated care partnerships (ICPs) (known as ‘local delivery plan’ areas): Central Lancashire; Fylde Coast; Morecambe Bay; Pennine Lancashire; and West Lancashire. The initial focus of the ICS was on the Blackpool and Fylde Coast area, building on work undertaken through the Fylde Coast multispecialty community provider (MCP) vanguard. This was seen locally as the most developed of the five ICPs. It has now been agreed with the national team at NHS England that rather than Blackpool and Fylde Coast being the sole focus, the wider catchment area of Lancashire and South Cumbria should be recognised as the integrated care system. 

As Blackpool and Fylde Coast, the population served was one of the smallest of the first-wave ICSs, but taken as the whole of Lancashire and South Cumbria, the population increases to 1.7 million, making it one of the largest. The Lancashire and South Cumbria ICS is co-terminous with the STP, and includes five CCGs, four acute trusts, one community and mental health trust, one ambulance trust and four local authorities. 

Partnership working is developing across the ICS, but is particularly strong within the individual ICPs, two of which – Morecombe Bay and Fylde Coast – were part of the national new care models programme. This collaborative approach is now being extended to all areas, with the aim of creating integrated working across the whole of Lancashire and South Cumbria both at the level of the five partnerships and across the entire system. 

ICS structure and governance

There is an overall ICS board, comprising representatives from constituent organisations, including non-executive expertise representing the Lancashire and South Cumbria population. It provides leadership and oversight of the delivery of the aims and objectives for the system. It meets monthly to consider progress on the implementation of the ICS’s aims and objectives and to manage risks across the system.

A programme management group supports the board and includes ICS executives with formal roles in the system as well as senior responsible officers for each of the workstreams and local partnerships. It also includes clinical leaders, representatives from each of the local authorities and five non-executive directors appointed from constituent organisations based on their competencies rather than geographical representation. This body has been described as the ‘engine room’ of the ICS, overseeing delivery of the overall ICS programme plan and reporting to the board on progress. 

Each ICP acts as a distinct health and care system, bringing together delivery of acute hospital services, community services, primary care, social care and voluntary sector services across their area. There is also a joint committee of CCGs to help co-ordinate commissioning decisions and actions across the ICPs and ICS.

As the ICS has evolved from covering Blackpool and Fylde Coast to the wider Lancashire and South Cumbria area, governance arrangements have had to change to reflect this. The arrangements have built on well-developed governance structures for the STP. As in other areas, existing statutory boards remain in place, and the role of bodies such as overview and scrutiny committees and health and wellbeing boards remains unchanged. The new structures, such as the ICS board and joint committee of CCGs, are therefore expected to have a strong relationship with these bodies.

ICS priorities

The four main objectives of the ICS are to:

• make faster progress on reform of the four priority areas: urgent and emergency care, primary care, mental health and cancer services

• manage improvements within a shared financial control total across CCG and provider partners

• integrate services and funding within a single health system

• act as a strong leadership cohort.

Work is under way to create a single control total combining the financial position for CCGs and providers. However, this has been challenging, as two of the providers have significant financial deficits. The Lancashire and South Cumbria ICS has therefore been unable to formally agree to a system control total. Efforts to resolve this are ongoing. 

Stakeholder engagement

A variety of engagement methods have been used, including public representation on the programme board, public events across the five areas and attendance at health and wellbeing boards and scrutiny reviews. There has been considerable engagement with all partner organisations across the whole ICS and within each ICP but a number of leaders within the system remarked on the challenge of communicating and engaging directly with the public. Much of the engagement work so far has been at the level of the ICPs.

Recently, work has been completed on a set of communication materials for a range of different stakeholders, which can be widely shared. It is hoped that this will help to improve understanding of and involvement with the work. The ICS is also developing plans for clinicians and other leaders to talk to the public about the work to build closer engagement with the wider community.

Key enablers

The features that have supported progress in Lancashire and South Cumbria are:

• a history of innovative, collaborative working within the two vanguard programmes, which has created a foundation to build on

• commitment from the ICS leaders to build a Lancashire and South Cumbria system, which exists alongside the five ICPs

• a strong focus on the different roles and responsibilities of both the ICS and ICPs

• strong involvement of local authority partners, particularly at ICP level

• positive relationships with the regional teams from the national bodies, who have been supportive of the local work.

Next steps

Many interviewees spoke about the need to deliver on planned service change, both within the ICPs and the ICS, building on the work that has been undertaken on governance and ways of working. One example given was the development of an improved winter plan for 2018/19. Securing and developing leadership at both place and system levels is seen as key to driving these improvements, including expanding clinical leadership and engagement. Patient and public engagement was also identified as a priority for further work. 

Interviewees also highlighted key strategic issues that are a priority for further work, including decisions around the provision of acute services in Central Lancashire and the organisation of specialist services across the whole ICS. Further work is also needed to agree a system control total, requiring agreement between local organisations and with the national bodies.