Collaboration and inclusive leadership at every level

Collaboration and inclusive leadership at every level are crucial to success for Integrated Care Systems (ICS)

Professor Claire Fuller, Surrey Heartlands ICS

The inception of new ICSs has brought the biggest opportunity in a generation for a radical overhaul in the way health and social care services are designed and delivered, to improve patient care and narrow the gap between those in the most deprived areas of England who overall, develop multiple health conditions ten years earlier than people in the least deprived areas.

We know that medical care alone will only ever impact about 20% of someone’s health and wellbeing; the rest – known as the wider determinants of health – is influenced by factors such as education, housing, employment the environment and personal characteristics such as race.  Only by working collectively – for example with local government colleagues, the community and voluntary sector – will we ever be able to make that shift to tackling the root causes of poor health.  That’s why this change is so important as it will give us the statutory framework to accelerate how we do this.

In Surrey Heartlands we have ambitious plans to improve health outcomes for local people.  As a system, we have agreed five health and care priorities that will help us transform our health and care system and ensure it remains sustainable into the longer-term:

  1. Keeping people well – doing more to promote prevention and stepping in earlier to prevent people’s health deteriorating; and when people do deteriorate, making sure they understand how and where to get the urgent help they need.
  2. Safe and effective discharge – helping patients, their carers and families understand and safely navigate the options available to them from a much more joined up and improved community care environment.
  3. High-risk care management – making sure those who are most vulnerable receive the care they need in a coordinated and planned way.
  4. Effective hospital management – making best use of hospital resources to support patients safely and efficiently from admission to discharge; and delivering high quality care based on the ‘Get it Right First Time’ principles.
  5. Through system wide efficiency programmes, looking at diagnostics, clinical networks, more efficient use of our workforce, digital innovation, how we use our estates and facilities and corporate and clinical support services.

But fixing these problems will only partially address people’s health and wellbeing needs. As I’ve highlighted, it’s tackling the wider determinants of health that will have the most lasting impact for our population.  And that’s why bringing broader partners together, to take collective responsibility for our overarching health and wellbeing aims is so critical.

Across Surrey, partners have already agreed a ten-year health and wellbeing strategy aimed at reducing health inequalities so ‘no-one is left behind’, focusing on supporting people to lead a healthy life, supporting people’s health and mental wellbeing, and supporting everyone to reach their potential.  Following the pandemic, we refreshed this strategy and a key part of that was to identify our top 18 areas of deprivation and priority populations that will help focus our work going forward.

As a working GP I have directly seen the effects of policies and processes that are not always as seamless as they should be, and which can have an irreversible impact on patients and their families.  Through Next Steps for Integrating Care – the national stocktake I led recently looking at the role of primary care within ICSs – it’s clear that the wider primary care team has a key role to play in the development of truly integrated teams.

At the heart of the report is the need to improve both the experience of accessing general practice and continuity of care – restoring the confidence of the public which is at an all-time low – and importantly to understand and support the critical role primary care can play in helping people stay well for longer through proactive care and earlier interventions.  Particularly ensuring those who would most benefit from continuity of care (such as those with long term conditions) can access more proactive, personalised support from a named clinician. This will not only improve people’s overall health and wellbeing but will also make a significant contribution to creating a more sustainable health service in the longer-term. 

In my view, and that of colleagues across the country, this will only be possible through positive partnership working and the development of ‘neighbourhood teams’ and ICSs are the perfect vehicle to facilitate this – supporting the creation of thriving partnerships at a ‘neighbourhood’ level with the knowledge and relationships to truly address health inequalities and the wider determinants at ground level.  These will be different in every community, so building partnerships from the ground up would seem the most sensible approach.  Here in Surrey Heartlands, we’ve already started to talk about the importance of developing integrated neighbourhood and place teams as the key vehicle for local care delivery – particularly for urgent and complex care and prevention - and how that needs to be the context for wider discussions and decision-making. 

Thinking back to our five key priorities – our first three – keeping people well through improved interventions and prevention; safe and effective discharge supported by an improved integrated community care environment; and high-risk care management, wrapping care around the most vulnerable – are all about delivery at place, and integrated neighbourhood teams will play a key role in how we do this.

And when we talk about primary care, we don’t just mean GPs, but our community pharmacy, optometry, dentistry and audiology colleagues – right on our high streets - who all have unique insight into the needs of our local population and play a key role in prevention and ‘making every contact count’.  

For this reason, I am delighted that the six South East ICSs, working together with the NHS England regional team have secured delegation of community pharmacy, dentistry, and optometry so that from the outset we can work in a truly integrated way.

Of course we need further change in how national policy is designed and implemented, enabling local teams to be supported to do the job they need to do. I encourage national partners including NHS England and the Department of Health and Social Care to continue to provide leadership in creating and supporting conditions for success and local flexibility, as determined by local leadership and delivery partners working on behalf of their local populations.

Above all, what matters most to me is how this benefits local people, the individuals I meet in my own GP surgery;  so when someone goes out to visit Mrs Smith, a frail older lady still living independently in her own home, it doesn’t matter whether they are from community services, the hospital Trust, social services or from the local GP federation – what matters is that Mrs Smith gets the care she needs, when she needs it, from a local team that is completely joined up and focused on what’s best for her.