Encouraging emergency services to join the ‘integration journey’

Catherine Levin continues her look at how the emergency services can work with integrated care systems (ICS), as she speaks to Sarah Walter the Director of the ICS Network at NHS Confederation about the recent Hewitt Report to find out how this new approach is working out.

A messy partnership landscape

The ICS is formed from the relationship between the NHS and local government to improve health in local areas; the emergency services are not statutory partners but are key players when it comes to reducing health inequalities through their own prevention work. It’s a messy partnership landscape in England where 11 ambulance trusts and 42 ICSs create a complexity and capacity challenge that is not lost on Sarah.

“We’re encouraging ICS to think hard about appropriate engagement routes, recognising there will be limited capacity for ambulance trusts whose expanse might be huge.” She cites the example of the Southwest where Dorset ICS holds the relationship for the region with Southwest Ambulance Service in a kind of primary authority style approach.

When it comes to the fire and rescue services and police, Sarah says that there is good work going on. The geography issue comes up and given the various ways in which fire and rescue services are organised, it is those who are part of county councils have the potential for more advanced partnership thinking. Sarah adds, “We see police and fire as important partners in the ICS and in the Integrated Care Partnership, the non-NHS statutory part of the equation that brings in a broader set of partners recognising their contribution to health in an area.”

Building on existing partnerships

Sarah makes the point that while the ICSs were legally established in July last year, it wasn’t the starting point for partnerships. She explains, “Many partnerships were already well developed and working effectively for some time; the legislation formalises the nature of the partnership.” The nature of the partnerships varies across the country in terms of who is involved and maturity of that relationship.

The Health Secretary commissioned his Labour predecessor, Patricia Hewitt, to carry out an early review of the ICS and this was published in April. In his response to the Hewitt Report, NHS Confederation chief Matthew Taylor said that a cultural and behavioural shift is needed to make the most of the ICS and I ask Sarah whether that suggests that the existing relationships need more work?  She says that the Health and Social Care Act brought in a shift in emphasis from hierarchy and competition to one based on a greater emphasis on collaboration and partnership.  “Reducing health inequalities will come from outside the NHS and that’s the shift that will result from the ICS approach.”

The Hewitt Report was commissioned so early in the process, I ask Sarah how meaningful it could be in terms of offering insights into how it’s bedding in. Sarah says that the NHS Confederation thought it was a good idea and welcomed the report, “We see it as a really helpful accelerator to progress that is already being made.”

Prevention theme

One of the strong themes in the report is prevention. I was taken by this quote: “Because ICSs are partnerships between all those involved in health, wellbeing and care, we can shift the dial on today’s immediate and urgent problems, bringing people together to work in different ways. By doing so, we start to create a new virtuous circle of supporting health and wellbeing, and in the process reduce the pressures on NHS emergency care.”

The virtuous circle is a commendable idea and if it leads to reduced pressure on ambulance services, it must be seriously considered. Sarah says that there is plenty going on already in the prevention space.

“We’re not starting from scratch here; we are looking at how we can further enhance and support partnerships. We recognise the urgent priorities exist but if we are solely focused on the here and now crisis situations, then we will never move ourselves forward.” She acknowledges that ICSs have a challenging job ahead, adding, “They need to be accountable and responsible for the services delivered today and must be looking at the future, thinking about the shifts they can make to move into the preventative space. The trick they need to pull off is to do both well.”

A path to maturity

The Hewitt Report also looks at ‘the path to maturity’ of ICSs. I’m interested in how partnership is part of a mature approach and whether that includes collaboration with emergency services. The Report introduces the concept of the High Accountability and Responsibility Partnerships (HARP). I ask Sarah where this idea has come from and how a HARP might be measured or even defined.  She responds, “One of the things that’s been a marker of Patricia’s work has been the significant engagement across the sector and how this has informed her views. The HARP idea emerged as a result. I think it’s an interesting concept. There is work to be done to explore it at a strategic level in the NHS.”

It is early days for the HARP concept and in the meantime, the ICSs will need some kind of regulation and an independent view on performance. That will come from the Care Quality Commission (CQC), which is being expanded to embrace the ICSs and, if Patricia Hewitt’s view is taken on board, will include a new Chief Inspector of Systems. Sarah says that the CQC is already talking to ICSs about how this will work and what methodology might be used.

Good practice for data sharing

Good data will underpin the inspection process and how to meet the challenge of sharing data across the organisations in the ICS and the wider partnership is one that ICS digital and data leads are already discussing. The NHS Confederation convenes this group and while there is good progress in some areas, there is further work to be done, says Sarah. “Data is a really important part of the integration piece as it is used to build an understanding of a local population and its health needs.”

The extent of emergency services involvement in the ICS as members of the Integrated Care Partnership is yet to emerge, but a good place to start is to look at the five-year strategy that each ICS has now published. Sarah encourages police, fire and ambulance services to review those strategies and be part of what she calls the ‘integration journey’.


Photo credit: NHS Confederation exhibition hall in Manchester.