A year of integrated care systems: South Yorkshire and Bassetlaw

The South Yorkshire and Bassetlaw (SYB) ICS covers the four boroughs in South Yorkshire – Barnsley, Doncaster, Rotherham and Sheffield – and the northernmost borough of Nottinghamshire, Bassetlaw. Covering a population of 1.5 million, it is one of the largest of the first-wave ICSs. 

Each of the five places within SYB have relatively high levels of deprivation compared with the rest of the country, with Barnsley and Doncaster in the top 15 per cent most deprived local authorities nationally. SYB also compares poorly with the rest of the country on a range of health measures, such as preventable mortality rates, smoking and obesity, and adult mental illness.

The ICS is made up of 23 members. This includes Barnsley, Doncaster, Rotherham, Sheffield and Bassetlaw CCGs. It also includes the following nine provider organisations:

• Barnsley Hospital NHS Foundation Trust 

• Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust 

• Sheffield Teaching Hospitals NHS Foundation Trust

• The Rotherham NHS Foundation Trust 

• Sheffield Children’s NHS Foundation Trust 

• Chesterfield Royal Hospital NHS Foundation Trust 

• Sheffield Health and Social Care NHS Foundation Trust 

• Rotherham Doncaster and South Humber NHS Foundation Trust 

• Yorkshire Ambulance Service NHS Trust. 

Other members include the local authority within each of the five places: Barnsley Metropolitan Borough Council, Doncaster Metropolitan Borough Council, Nottinghamshire County Council / Bassetlaw District Council, Rotherham Metropolitan Borough Council and Sheffield City Council. They also include nearby providers Nottinghamshire Healthcare NHS Foundation Trust, South West Yorkshire Partnership NHS Foundation Trust, East Midlands Ambulance Service NHS Trust and Doncaster Children’s Services Trust.

The ICS builds on a history of joint working across South Yorkshire and Bassetlaw. This includes the Working Together programme – an acute care collaboration which became a vanguard in 2015 – and the Commissioners Working Together collaboration. The establishment of the sustainability and transformation partnership was seen as a key step in closer working and joint planning between the organisations, and the basis for the ICS.

While joint working is continuing to develop at the level of the ICS, organisations are continuing to focus much of their attention at a place level. Each of the five places within SYB has developed an Integrated Care Partnership (ICP), and these are seen as the ‘building blocks’ of the ICS. The ICPs include the relevant NHS providers and commissioners, as well as local government and the voluntary sector, and therefore are the main mechanism though which local authorities are engaged in the work on integrated care.

ICS structure and governance

SYB’s governance is currently being reviewed, with the revised approach expected in autumn 2018. Its current structure includes a collaborative partnership board, which meets monthly and is responsible for agreeing the ICS’s strategy and monitoring performance. While the partnership board is not a statutory body, it can make recommendations for its members to consider formally through their own governance structures. The board’s membership is very broad (approximately 40 people), including all ICS members, as well as others such as local Healthwatch groups, representatives from the voluntary and community sector, and NHS England and NHS Improvement staff.

An executive steering group oversees delivery and makes recommendations to the partnership board on transformation funding spend. The steering group includes chief executives, accountable officers and others from the member organisations’ leadership teams such as strategy and finance directors. The programme boards, which report to the steering group, are responsible for delivering key priorities. Each is led by a chief executive and accountable officer. 

There is some scope for the SYB partners to make collective decisions through a joint committee for commissioners, which has delegated authority for hyper acute stroke services and children’s surgery, and providers’ committees in common. Under current arrangements, however, these two bodies are unable to take joint decisions. 

It is expected that the ICS governance structure will continue to develop over time – for example, to increase the scope for shared decision-making and to simplify the structure further. The ICS is also reviewing where there are opportunities for further collaboration. In addition, it has plans to develop a single assurance framework, to increase transparency between the constituent organisations, and to change its relationship with regulators.

ICS priorities

The ICS’s priority workstreams include the following:

• Four national priorities:

  • primary care

  • urgent and emergency care

  • cancer

  • mental health and learning disabilities.
     

• Five local priorities:

  • living well and prevention

  • elective and diagnostics

  • children’s and maternity

  • digital and IT

  • medicines optimisation. 

A key focus for the ICS has been an independent hospital services review, which was set up to review the sustainability of some acute services across SYB (as well as in two providers outside the ICS) (see box). The outcomes of the review will require the providers involved to work in different ways, acting as ‘one system’, as well as greater collaboration between commissioners. The ICS has also made a decision to reconfigure hyper acute stroke services across SYB, the implementation of which is now under way.

Some work has also been undertaken to improve integrated working at a place level, to shift care out of hospitals and into community settings, as well as work to develop primary care and encourage GP practices to work at scale.

Stakeholder engagement

To support engagement of patients and the public in its work, the ICS has developed a Health and Care Working Together engagement framework and appointed a dedicated public and patient involvement manager. A number of engagement events have been carried out with the public, and the ICS has established a citizens’ panel to support the workstreams.

In practice, much of the engagement to date has focused on specific service changes, such as changes to hyper acute stroke services, rather than on the structure of the ICS itself. (In the case of stroke services, public involvement has also taken the form of a challenge to the proposed changes through a judicial review.)

Work has also been undertaken to engage staff in the development of the ICS, including an ICS staff partnership forum as well as activities at the place level. Again, in practice, staff have been most engaged in service changes that are likely to involve them (such as the hospital services review), while engagement in the ICS itself is stronger at a senior level.

Key enablers

Factors which have supported progress in the SYB ICS include:

• a strong history of working together in South Yorkshire and Bassetlaw

• a long established and well-respected chief executive as ICS lead, with significant experience of South Yorkshire and Bassetlaw 

• progress within ICPs at a place level

• having decision-making mechanisms in place through the joint committee for commissioners and the providers’ committees in common 

• senior leadership of workstreams (all led by chief executives and chief officers).

Next steps

As mentioned above, the ICS intends to continue developing its governance structure to ensure that robust arrangements are in place to support next steps – for example, becoming a live ICS and starting to take responsibility for managing system-wide operational and financial performance, and a system control total. It also intends to make further progress in developing a single assurance framework, such that over time the regulatory function would be embedded within the ICS.

In terms of service changes, a clear priority for the ICS is responding to and taking forward the recommendations of the hospital services review. This means not only implementing new ways of working within the acute sector, but also developing primary care and community services alongside these changes.