Health and social care organisations in Derbyshire have been working closely together for some time, to improve care and services for people and make them as efficient and effective as possible.
While operating at these four levels, there will remain the statutory organisations who make up the partnerships. This includes NHS Foundation Trusts, GP practices, local authorities (county council, city council and district and borough councils), the voluntary sector, police, fire and rescue and others. These organisations will all continue to exist, employ people, have statutory accountabilities and a clear identity with the public. Through the ICS structures people within them will be working more and more closely together in the new partnership/collaborative structures.
There is also the opportunity to develop new partnerships that span existing boundaries, where developing services at larger scale can use specialist skills and expertise to the best effect for our population.
These different tiers exist as there is a clear need for collaboration in smaller geographies within our ICS, as with one million people in Derbyshire the ICS would be too far removed from the distinctive needs and characteristics of local populations. At the system level, we do need to set consistent policy so that services are commissioned and provided equitably where that is needed. There will be a range of delivery points for our collaboration, overseen by an NHS ICS Board and a Partnership Board. Much of the rest of the ‘architecture’ is to be determined, but will include the elements in the diagram below:
The role of Place Partnerships and the Local Place Alliances is to:
Build relationships with communities and work with them to create a shared purpose for Place, and shared priorities
Ensure we are listening to local people as a system, not as individual organisations
Redesign local services where appropriate
Join up care pathways across the NHS, local government, and VCS services
Support the development of the Primary Care Networks (PCNs)
Develop multidisciplinary teams
Deliver preventive interventions for people with complex care needs
Once developed, Place Partnerships will have significant responsibilities and budgets and will do most of the heavy lifting in the ICS. They will bring together a broad range of partners - including local government, NHS providers, voluntary and community sector organisations, social care providers and other partners acting on the full range of factors that influence health and wellbeing – to join up the planning and delivery of services through a multi-agency approach and to address the social, economic, and wider health needs of their population.
The White Paper Integration and Innovation: working together to improve health and social care for all sets out an expectation that place-based partnerships should form a central part of ICSs. However, arrangements at place level will not be given a legislative basis and local systems will be free to develop their own arrangements, building on existing partnerships where these are working well.
There is more information about work on place here.
Provider collaboratives are set to become a key part of our ICS in the next few years. The exact form and function these will take is still to be decided, and further guidance is expected, however they could take a number of different forms and will vary in their scale and scope. Some will be ‘vertical’ collaboratives involving primary, community and local acute, mental health and social care providers coming together to join up their services; others will be ‘horizontal’ collaboratives involving providers working together across a wide geography with other similar organisations to transform services and/or improve quality and efficiency. All NHS providers will need to join a provider collaborative and individual providers may be involved in more than one.
Providers of services in Derbyshire are already playing a critical role in the changes underway, working hand in hand to plan care for Derbyshire’s population, for example contributing to and leading work at the ICS level on the Joined Up Care Derbyshire Board to plan and transform services and improve system performance. Also collaborating with other local providers at local Place Alliance level to redesign care pathways and deliver more integrated services for local people. For example, ‘Team Up’ which can be found in section one of the ICS Explained document (see below).
Collaborations will also be formed outside of traditional service or geographic boundaries, where this makes sense for services and patients. This is likely to be because the specialist nature of services means they need to be provided at greater scale to support workforce requirements. This type of arrangement already exists for some services, including ambulance services, NHS 111, fertility services and some mental health services. We will work with partners to understand how this can be expanded to include primary care services and others.
Distinct commissioning and provision responsibilities will technically remain in separate organisations under the proposed legislative changes, but in practice the division will be blurred as providers will be represented on the ICS NHS body board in tandem with the NHS strategic commissioning approach. Additionally, where place partnerships and alliances are given budgets and authority, providers will be involved in the identification and delivery of priorities at a local level, thus further blurring the commissioning/provision roles. CCG staff will transfer into the ICS, but this will be a very different organisation, with greater integration of teams looking at how to address local health and wellbeing priorities.
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