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• Government publishes response to reviews on integrated care systems
• National targets to be reviewed and streamlined to enable local health and care systems to focus on improving the health of local people
• More effective care systems could help to cut waiting lists

The government has committed to a number of measures to support integrated care systems in response to two key reports.

Responding to the Hewitt Review which reported its findings on 4 April and the recent Health and Social Care Select Committee (HSCC) Inquiry into the workings of the local health and care systems, the government reaffirmed its support for integrated care systems.

In its response, the Department of Health and Social Care (DHSC) outlines the steps it will take working with NHS England and local health and care systems, to support learning and improvement and join up care for patients and communities. As part of this the department will review and streamline national targets to ensure that systems are able to focus on improving health for their populations.

In line with the recommendations of the reviews, the government has also committed to:

• Continue supporting local systems to adapt to NHS England’s new operating framework, which lays out the new roles NHS England, Integrated Care Systems (ICS) and NHS providers will play in the wider health and care system
• Work with NHS England, local authorities and local health and care services to develop better information around funding for prevention services to inform future investment decisions
• Provide greater certainty over budgets for local health and care systems, by working to ensure reporting for small in-year funding pots is proportionate, freeing up time for planning and delivery of health and care to local people

The actions from the government’s response will support health and care systems to be more effective, making them a vital tool for improving the speed at which people will receive care in their local areas and in some cases reducing their need to be placed on an NHS waiting list where community support is available.

Government will be looking to take these commitments forward over the coming months, working with national partners and systems.

 Minister for Care Helen Whately said:

“Integrated care systems are already making a difference by bringing together local NHS organisations along with social care and the voluntary sector. We know that joined up care benefits patients and that’s exactly what ICSs are there to provide.

“We have listened to the reports and the actions we’re going to take, like reviewing how we reduce admin burdens on local systems, will build on the excellent work that ICSs are already doing.”

 Amanda Pritchard, NHS chief executive, said:

“Integrated care systems have the power to change the way the NHS provides care for people while working alongside local government to ensure people live healthier lives.

“Health systems across the country are already making a real impact and we will continue to support local areas to improve outcomes for patients.”

Integrated care systems bring together NHS, local government, social care providers, charities and other partners to deliver on four goals:

• Improving outcomes in population health and healthcare
• Tackling inequalities in outcomes, experience and access
• Enhancing productivity and value for money
• Helping the NHS support broader social and economic development

Each ICS has an integrated care board that includes representatives from local authorities, primary care and NHS Trusts and Foundation Trusts, who make decisions on commissioning health and care services in their local areas.

The Health and Social Care Committee launched its inquiry into integrated care systems in July 2022. Subsequently, the Health and Social Care Secretary commissioned Rt. Hon. Patricia Hewitt to lead a separate, independent review in November 2022, to examine how the oversight and governance of these systems can best enable them to succeed.

Both reviews covered ICSs in England including considering the NHS targets and priorities for which ICBs are accountable, including those set out in the government’s mandate to NHS England.

Drawing on the insights of leaders from across the NHS, local government, social care providers, the charitable and the voluntary and social enterprise sectors, the Hewitt review looked at how best to empower local leaders to focus on improving outcomes for their populations.

Further information

• Government response to Hewitt and HSCC reviews on Integrated Care Systems: https://www.gov.uk/government/publications/government-response-to-the-hscc-report-and-the-hewitt-review-on-integrated-care-systems
• Each ICS has an integrated care board (ICB), a statutory organisation responsible for developing a plan for meeting the health needs of the population, managing the NHS budget and arranging for the provision of health services in the ICS area. ICBs include representatives from local authorities, primary care and NHS Trusts and Foundation Trusts.
• Each ICS also has an integrated care partnership (ICP) that brings together a broad alliance of partners concerned with improving the care, health and wellbeing of the population. The ICP is responsible for producing an integrated care strategy on how to meet the health and wellbeing needs of the population in the ICS area.

The AHP Professional Bodies met with the Chief Medical Officer (CMO), Professor Sir Chris Whitty and Chief Allied Health Professions Officer (CAHPO), Suzanne Rastrick.

Subject discussed was AHP contributions to Health in and Ageing Society

BAPO, along with the other AHP Professional Bodies attended a face-to-face meeting in London with the CMO and CAHPO, called as part of an exercise to collate information relating to the ageing population and who health could be promoted to enable those living longer in England to live happier, healthier lives.

Context

The CAHPO’s AHP Strategy for England: AHPs Deliver, has been developed to provide direction to the AHP community across England; to help the AHPs maximise their contribution to improving health outcomes, provide better quality care, and improving sustainability of health and care services.

Focus

The challenges of the AHPs Deliver included those of an ageing population. The challenges are not uniformly distributed and will be greater in our rural and coastal communities. BAPO were able to add comment that this is especially a challenge for prosthetic services, where services are most frequently located in the larger urban locations. In addition, those from rural and coastal populations who need to access orthotic services, can find access difficult, often due to workforce challenges.

The governments’ objective is to promote health and enjoyment, so later life has quality, with dignity retained. As part of the levelling up agenda there is a goal to add an average of 5 years of healthy living, promoting this over longevity. Currently there in areas of poor health the average for healthy living is 19 years lower.

Noting the six major conditions which contribute to the burden of disease in England, which are;

• Cancers
• Cardiovascular diseases, including stroke and diabetes
• Chronic respiratory diseases
• Dementia
• Mental ill health
• Musculoskeletal disorders

These areas account for around 60% of total Disability Adjusted Life Years in England. Whilst prosthetic and orthotic services are positioned to treat ageing patients with all these conditions, BAPO confirmed that cardiovascular diseases and musculoskeletal disorders are amongst the most common.

To support the achievement of the targets AHPs were encouraged to think how services could be commissioned with a focus on outcomes or outputs as opposed to inputs. BAPO were able to confirm that this is highly significant for prosthetic and orthotic services, where often service design is determined by the units and commodities purchased, including services and products, rather than the health outcomes achieved.

Summary

AHPs promoted the benefits of positive public health messages to the younger population, as healthy living in youth is related to health and wellbeing when ageing. The value of early rehabilitation to save money was highlighted, and this ties into enabling and empowering people to be able to work longer in good health and contribute positively to society. The message was good quality work supports good physical and mental health and APHs are effective in supporting this.

Recognising the significant economic challenges that an ageing population will create, it was accepted and recognised that AHPs will have to demonstrate that the care they provide is both effective and delivers value for money. However, in relative terms and when harnessed with a strong support worker resource AHPs are well placed to deliver many of the required solutions.

Final note and call to action to the professional bodies

It was confirmed that there is a call for evidence launched to invite views on how best to prevent, early diagnose, treat, and manage the 6 major groups of conditions which drive ill health and contribute to the burden of disease in the population in England[1].

The 6 major health conditions – cancer, cardiovascular diseases including stroke and diabetes, chronic respiratory diseases, dementia, mental ill health, and musculoskeletal disorders – affect millions of people in England with data showing that one in 4 suffer from 2 or more of these major long-term conditions.

Recognising the pressure these conditions are putting on the NHS, the government is seeking views on a new strategy to tackle them that will focus not only on treatment but also on prevention[2].

This consultation closes at 11:59pm on 27 June[3].

 

[1] Government Action on Major Conditions and Diseases Written statements – Written questions, answers and statements – UK Parliament

 

[2] Government invites views on tackling major conditions in England https://www.gov.uk/government/news/government-invites-views-on-tackling-major-conditions-in-england

 

[3] https://consultations.dhsc.gov.uk/645cb4b614fbee6d990990c9

 

Peter Iliff has represented BAPO in London at a meeting between the AHP professions,  the Chief Medical Officer, Professor Chris Whitty and Chief Allied Health Professions Officer, Suzanne Rastrick.

The meeting was an opportunity to promote the role of prosthetists and orthotists in positively influence healthy ageing within the population. 

Document – BAPO Healthy ageing and the role of prosthetics and orthotics personnel