ICS structure and governance
The leadership team of the ICS meets monthly. Membership includes chief executives and accountable officers from the constituent NHS organisations, chief executives of the two county councils and clinical representatives from the transformation boards. A number of groups report into the board, including a clinical reference group, advisory group and finance group. There are several agreed system-wide programmes and supporting and enabling workstreams, which also report into the board.
The mid-Nottinghamshire and Greater Nottinghamshire transformation programmes each have their own boards, with supporting project management offices and governance arrangements. In mid-Nottinghamshire, this is underpinned by an alliance contract. The membership of these boards is broader than the ICS board and includes representation from non-statutory bodies such as third sector organisations, citizen advisory groups and patient representatives. Both report into the overall ICS leadership board.
As elsewhere, the governance arrangements are emergent and expected to evolve. A recent addition is an advisory and oversight group that includes chairs of NHS organisations and elected council members. There is an ongoing dialogue about how the ICS governance and two transformation boards should operate. On one hand, it is important to avoid duplication and ensure clarity about roles and responsibilities, while, on the other, it is important not to undermine progress or lose local sensitivity.
The agreed system-wide priorities are to:
- promote wellbeing, prevention, independence and self-care
- strengthen primary, community, social care and carer services
- simplify urgent and emergency care
- deliver technology-enabled care
- ensure consistent and evidence-based pathways in planned care.
Other priorities include developing a single clinical services strategy and work on housing, estates and the workforce.
Progress towards these priorities varies across the area. Many of the changes that have already taken place are a consequence of the vanguards. Changes include the introduction of integrated multidisciplinary teams to support people with complex needs in the community, GP hubs, targeted proactive interventions in primary care for specific patient groups, and enhanced clinical support for care homes. Both vanguards have reported positive evidence of the impact of their models, and much of the ICS’s focus will be on spreading these more widely. A significant element of the work in Greater Nottingham (and the principal reason for this area being the early focus for the ICS) is the development of a detailed understanding of population needs and service utilisation across the system through data and analytics.
A number of pieces of work have been done to engage the local population in shaping the transformation agenda. Most of this predates the ICS. Several well-attended public events were held following the publication of the STP. More than 400 people attended these events and provided feedback on the plans, and further views were collected through an online survey. An update to the STP was published in July 2017, including a number of changes to the initial plan based on the feedback received from the public.
The ICS works closely with local Healthwatch organisations, which have provided support in planning and delivering engagement events. There is also a systems advisory group, which includes patient and public involvement leads from the constituent organisations. Additional engagement work has taken place at a more local level in the two transformation areas.
While interviewees were generally positive about the engagement work undertaken for the STP, they still identified it as an area where more work could be done, and some reported that these elements of the work have been less strong in recent months.
Features of the local system that have supported progress include the following.
- A history of collaboration and partnership working in the two ‘transformation areas’, which meant there were strong local relationships and advanced local examples of integrated service models on which to build.
- Respected and influential leaders driving forward the changes locally, including examples of strong local authority and clinical leadership.
- Recent changes in local leadership were viewed by some as being helpful in bringing a fresh perspective on the system and driving further change.
- Dedicated resource and capacity to work on the ICS through the secondment of a managing director from the NHS England regional team.
- A good understanding of local population needs and system capabilities, developed through detailed analytical work.
A key priority for the Nottingham and Nottinghamshire ICS is to develop further clarity about the role of the ICS and the two transformation areas. This includes exploring where different functions – particularly commissioning functions – should sit within the new system and taking steps to reduce duplication between the different levels of partnership working.
A key priority is to deliver on planned service changes and to continue to spread examples of good practice across the whole ICS. There are also decisions to be made about the nature of any further work with Centene, and what the nature of a relationship with any potential external partner might be.