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The first Levelling Up Commission inquiry sessions of 2023: The role of integrated care systems moving forward

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The Levelling Up Commission has held its first virtual inquiry sessions of 2023. The session was chaired by Janet Budd, the Director of the NHS Transformation Unit and the focus was on health and social care and how this sector intertwines with the levelling up agenda.

The online discussion was split into two halves. In the second hour, Janet was joined by three individuals with a keen interest in integrated care systems (ICSs). They were Geoff Little, the Place-Based Lead for Bury Council’s Health and Care, Richard Stubbs, the Chair of Yorkshire and Humber Academic Health Science and Sarah Reed, a Senior Fellow at the Nuffield Trust.

After the first hour, where Janet spoke to different panel members about the relationship between preventative care and health inequalities, she moved the focus of the topic on to ICSs and whether or not they are in a position to narrow health inequalities and level-up deprived areas.

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Janet Budd, the Director of the NHS Transformation Unit speaking at the inquiry session

ICSs and health inequalities

Devolution has played a key role in British politics for several years, with more and more power slowly being given to local authorities and councils over time. One area which has remained with the central government, until recently, was health.

However, as per 2022’s Health and Care Act, 42 integrated Health Care Sytems were established across the UK last summer.

These new systems are regional partnerships between NHS organisations, local authorities, and other local health and care providers, designed to bring together health and social care services in a coordinated and collaborative way.

There is some debate, however, about whether these systems have been designed adequately to deal with health inequalities. As far as Geoff Little is concerned they have to a point but, he would still like to see improvement. In terms of what he would suggest, Little said the following:

“My first suggestion would be to push for further delegation of power. Not only within the NHS but also across Whitehall to ICS and that delegation shouldn’t just be to ICSs but from ICSs too to local authority level partnerships and neighbourhoods.

We need double and triple delegation to promote two-way accountability – one way to NHS England and parliament and the other way to local democracy.

My second suggestion would be around neighbourhood level where we need to improve structures and relationships with carers, friends, families, neighbours etc. We need to work directly with those experiencing inequality to help change our systems for the better. Once we are doing that, each ICS will be able to develop its own programme for real substantial change.”

Changing the culture

For Sarah Reed, who works as a senior fellow for an independent health think tank, the culture within the NHS from the top down needs to change in order for ICSs to be able to work effectively against health inequalities. Reed said:

“There is a noticeable difference in the buy-in to the vision of the ICSs in terms of their potential to narrow health inequalities. There needs to be an effort to get the balance right between central and local control.

The reality is that there’s a top-down culture in this country which means the NHS is most accountable upwards rather than outwards. While we live in this culture, it will hinder a long-term approach to tackling health inequalities which is what is needed. Ultimately, a huge culture change is needed.”

Digital services within ICSs

One point which was brought up within the session was the idea of digital services and how they factor into health inequalities. The introduction of digital services within the health and care sector has always been inevitable and they have seemingly been fast-tracked as a result of the Covid pandemic.

Richard Stubbs has highlighted his belief that digital health services have the potential to “exacerbate” health inequalities. The Chair of Yorkshire and Humber Academic Health Science said:

“One of the issues I would like ICSs to look at is digital technologies. There is huge potential for digital services to exacerbate health inequalities. We need to think carefully about how we use these digital services in relation to how people can access them.

We should be considering who has access to things like broadband, data and confidential online spaces – all of these things are crucial.”

How the government can better support ICSs

With all three-panel members highlighting potential flaws in the current system when it comes to combatting health inequalities, the government may be placed in a situation where they have no choice but to intervene and tweak how these new ICSs work. Little believes that the key to a brighter future is through communication and further delegation:

“The government need to step back and look at how ICSs can help them reach its own targets and then make a case for further delegation. Delegation is good for the government because it can help them to achieve NHS targets in emergency and elective care but also labor market productivity and levelling up.

The government need to create a space for local innovation and programme delivery, and we need a rolling three-year budget for ICSs so that we can move away from short-termism. ICSs should then be given the freedom to allocate this budget in line with their local priorities. We have to trust local authorities more.”

View the full Inquiry Session here

Altering the metrics that ICSs should be assessed against

To steer ICSs in the right direction moving forward, key data and metrics are going to be vital. But, what outcomes should they be assessed against directly to ensure health inequalities targets are met? Little said:

“This is about wider public serves not just NHS metrics. We need less detailed NHS targets and more balanced “scorecards”. These scorecards will help us to look at things like how levels of activity in deprived neighbourhoods compare to the national average and whether levels of school exclusions are going up or down.

A wider range of metrics should be looked at for each locality that are appropriate to that individual area rather than everywhere having the same ones.”

Richard Stubbs added:

“Trends over time are important, perhaps more important than absolute measures. In terms of metrics, we often focus on what’s been invented locally rather than what’s been adopted. We should start championing areas that have “stolen with pride” from neighbouring communities for vital interventions.”

Summary

  • The session was the second half of the Levelling Up Commission’s first inquiry sessions of the year.
  • The three panellists were Geoff Little (a Health Lead in Bury), Richard Stubbs (Chair of Yorkshire and Humber Academic Health Science) and Sarah Reed (a Senior Fellow at an independent think tank)
  • The panellists discussed how useful ICSs are at tackling health inequalities in their current form, the areas that concern them and their own personal suggestions on how ICSs can be improved.
  • The panellists agreed that further delegation to local authorities is needed.
  • The panellists agreed that the government needs to intervene and tweak how ICSs work to better support individuals who suffer from health inequities.
  • The panellists believe that the NHS’ targets are a hindrance to narrowing health inequalities as they are too short-term.
  • The panellists believe that a culture change from the top down is needed within the NHS.

Recommendations from the panel

  • The government should step back and realise that ICSs can help them achieve their own targets.
  • Each locality should have its own bespoke targets when it comes to tackling health inequalities rather than generalised ones.
  • The government should provide ICS with a three-year rolling budget to get away from short-termism.
  • The government needs to trust local authorities more to allocate these budgets accordingly.

Final thought

The second half of the inquiry session was just as engrossing as the first half with all three panellists offering expert analysis on ICSs and how they can support the Levelling Up Agenda. The recommendations that each panellist suggested will now be drafted up by the Commission and sent to the government for consideration.

Given the expertise of those on the panel, the government would be wise to take what they’ve had to say on board.

Levelling Up Commission
To learn more about Curia’s Levelling Up Commission. Click here.

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