In March, Chamber hosted the first ‘Integrating Healthcare’ seminar in Manchester. Key figures from across Parliament, local and regional government were in attendance, as were clinicians and academics to discuss Integrated Care Systems (ICSs) and population health in the North West.
The “Programming, Prevention and Equity into Care Systems” panel was hosted by Professor Iain Buchan, joined by Rowan Pritchard-Jones, Joe Rafferty and Geoff Little. The panel all had experience working with ICSs so they were well-placed to discuss topics ranging from the relevance of research in ICSs to the role of volunteers in integrated care.
To kick things off, all three panellists explained a little bit about their current roles and their general thoughts on the new connected way of delivering health services across the UK. Rowan Pritchard-Jones, the medical director of NHS Cheshire and Merseyside, said:
“I’m now a medical director of one of biggest integrated care systems in the country and we have some of the deepest deprivation, too. Our mission, as an ICS, is to do things differently, to be precise with interventions and to take our community on a journey that will empower them with their health.
Meanwhile Joe Rafferty, Chief Executive of Mersey Care NHS Foundation Trust, spoke about how he wanted to get to a place where his trust can “tackle health inequalities through connected data” and to “use this data to make more agile decisions.”
Finally, Geoff Little spoke about his long career in Greater Manchester. Before retiring recently, Little was the Chief executive of Bury Council, a place-based lead for ICSs in Greater Manchester. He said:
“I’m passionate about the role between the NHS and local democracy in reducing health inequalities. My experience tells me that this is the centre of the way forward if we are serious about reducing inequalities.”
The relevance of research in Integrated Care Systems
ICSs have been designed so that different parts of the health system work together as one unit to improve outcomes for patients. It means that services such as mental health and social care, for example, are now connected and work as one rather than separately.
Some have suggested that this new way of working will mean that research is less relied on but for Rafferty, this couldn’t be further from the truth. He said:
“Research hooks into innovation and addresses issues such as young professionals who go to a certain city for university but then leave as soon as they graduate due to lack of opportunity. It’s still very much relevant and important – we need to take research and build out from it.
“At the minute, many Integrated Care Boards (ICBs) are dealing with urgency care. There’s a risk, though, that this urgency drives out the need for a longer-term perspective. This is where research and data should come into it.”
Pritchard-Jones is also a big believer in the role research can play within ICSs. Talking about the great work that researchers are doing in his ICS, he said:
“Our Directors of Research are currently creating an Integrated Research System where patients can access research closer to home which will mean that we obtain better results which in turn will mean we can solve more problems.
“As things currently stand, many deprived individuals have to take six buses to get to a research appointment which just isn’t feasible. This new system has the potential to be a highly functional environment which works well for everybody.”
The way in which ICSs are going to become more effective is by utilising data to introduce preventative measures. These measures will be steered by predictive data that should be gathered at a very granular level. Pritchard-Jones said:
“For any individual, 90% of their journey to ill health happens before they ever see a doctor -it’s formed by thing like their local environment, occupation and heritage. We want to work with local authorities to find out things like who is living in a cold home, who is living in a mouldy home etc.
“In Knowsley, our respiratory teams have been working with local housing authorities to help these types of individuals and to remove them from these homes before health problems start to kick in.
“The World Health Organisation says that ‘health intelligence is data that you can action’ and that is a really important point. When our data becomes health intelligence it will lead to meaningful action for the most deprived individuals.”
Geoff Little believes that taking the time to evaluate can bring about the most predictive data. He said:
“There’s never been a better time for evaluation. We’ve got to be prepared to be wrong about certain things and look back and learn from our mistakes. If accountability systems are too top-down then that removes fearlessness from our research and innovation.
“I think you’ve got to innovate and improve prevention and early intervention at the interface between public services and systems with the people and communities that experience deprivation and inequalities.
“We have to understand these places through direct contact with people in those communities as well as data. Stop telling these people to live their lives and talk to them to understand them better.”
Rightly or wrongly, volunteers have played an increasing role in delivering health services to patients in recent years. Will that change with ICSs? Geoff Little doesn’t believe so:
“The voluntary sector will be at the heart of the action on the ground. We need to be focused on our improvement at the interface between the people who suffer the most and public systems and services.
“At that interface, you’ll find community organisers, activists, and people who are trying to give people on the ground some voice and agency in affecting the traditions that they live in. It’s not for me to get anywhere near politics on this but there’s got to be an acceptance that the most deprived people think they aren’t listened to.
“We do need to use volunteers at a micro level to really help us connect to people.”
The panel discussion highlighted some important issues and challenges facing ICSs in the UK. The panelists’ emphasis on the importance of research, data, and community engagement in improving public health outcomes is a positive step towards creating more effective and equitable healthcare systems.
However, the discussion also highlights the ongoing challenges of addressing health inequalities and ensuring that healthcare systems are responsive to the needs of local communities. The panelists’ emphasis on the need for a more agile and responsive approach to healthcare, with a focus on prevention and early intervention, is a welcome recognition of the need to move beyond traditional models of care that often focus on treatment rather than prevention.