Second, Foundation Trusts must recognise their role and impact as anchor institutions in local communities. ICSs in some instances may need to help ensure every hospital develops this anchor role. Once recognised FTs must then work in partnership with local government, the voluntary sector and local businesses to address health inequalities in their local populations as well as inequalities in access to health services.
Third, the goal of equality, as well as quality, should be embedded in ICS and organisational codes of governance. Evidence was presented showing how institutional resources are being shifted upstream towards prevention. The ‘bottom-up’ voice of communities and ‘top down’ action by system leaders should be combined to crack the challenge of improving the population’s health and reducing health inequalities.
Fourth, ICSs offer a chance to move beyond institutional and silo thinking, towards a whole system approach to deliver health improvement through a wide agenda for action including air quality, regeneration, transport, housing, employment and skills. However, the Commission recognised that delivery on this agenda will not be quick as the public’s expectation for the prioritisation of acute services – for example cancer treatments – will remain.
Fifth, it is simply wrong that children in severe mental health distress are now being put on a waiting list. ICSs must put children’s mental health at the top of their agenda ensuring that all partners – NHS, local government and the voluntary sector – act to reverse the current situation. It was noted that excellent recommendations for reform of children’s care services by Josh McAllister are in danger of being overwhelmed by the impact of the current mental ill-health epidemic.
Sixth, for ICSs to manage the landscape for children and young people – which includes education as well as the NHS, local government and the voluntary sector – will require joint action locally and a more joined up approach between DfE and DHSC. Effective data sharing is still not in place and there are no dedicated national funding streams for children’s health as there are for conditions such as cancer.
Seventh, care services for children and young people should not become over-medicalised but address the wider social, family, financial, educational and cultural factors influencing their growth and development. Schools must be fully engaged in the strategy and recognise their role as anchor institutions in local communities. And the voice of children and young people is essential if change is to be successful.
Eighth, every ICS should develop a children and young people’s policy framework based on a common set of design principles and containing clear indicators of success. Place-based partnerships should include informal support in the community as well statutory services for children. National cross-departmental leadership between health, social care and education is required to support local integration.
Ninth, ICSs should be committed to parity of esteem between physical and mental health services. They will have a critical role to play in improving people’s mental health, improving the services they rely on, reducing health inequalities and improving access to mental health services for marginalised groups in need.
Tenth, ICSs should develop a fully funded post-covid mental health recovery plan for their area supported by a robust workforce development strategy. Mental health services should be represented at every level in the ICS system with a full place on the ICS Board. And there should be a process to allow the voice for mental health service users to be heard at every level – the ICS system, place-based partnerships and neighbourhood PCNs.
Eleventh, ICSs should do more to ensure people with a learning disability can lead an active, full and healthy life. There are huge inequalities in health and life expectancy of people with a learning disability that ICSs should address as a priority. The ICB Board member for Learning Disabilities and Autism should use their position to pro-actively monitor and encourage progress.
Twelfth, ICSs should develop a learning disability action plan including driving up the numbers on the Learning Disability Register (a passport to other services and benefits). They should also seek to exceed their national target for Annual Health Checks and ensure GPs provide a Health Action Plan for all people with a learning disability.
In conclusion, ICSs offer a very real and unique opportunity for implementing the next chapter of reform in our health and social care system and one in which health inequalities are centre stage. There is genuine optimism ‘on the ground’ and strong support from NHS England and Improvement.
However, good institutional architecture and better relationships between NHS local government and other partners, will only go so far. Supportive central Government action, including stemming growing inequality and poverty, is crucial. Making inroads on health inequality will require not only local collaboration but also central Government action.
To read the full report of the roundtable click here.
For an invitation to the next roundtable which will consider Developing ICS Best Practice on the key issues of Workforce Development, Partnerships at Place, and System Regulation and at which the Minister for Integration, Gillian Keegan MP, is speaking please email [email protected]