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Community services have the chance to show the rest of the NHS what integration really means

Community services are set to play an increasingly vital role in the post-pandemic NHS. John Copps and Matt Carter argue that the rapid movement to integrated care systems mean that community trusts have an opportunity to place themselves at the centre of local plans and show the rest of the NHS how integration is done.

Of all the limbs of the NHS, community services is where the interfaces with other public services is most evident. Unlike other parts of the NHS, the connections with adult social care, housing services and social security are not limited to transition points – they are part of the day-to-day, often in the same room.

After years of debate, discussion and policy, the experience of COVID-19 has now made integration an imperative.

This push for integration adds to the momentum of the 2019 NHS Long Term Plan, and its emphasis on Population Health Management, patient care delivered closer to people’s homes, and prevention. As part of this overall shift, all health systems are required to become ‘Integrated Care Systems’ (ICSs) by April 2021, a fact re-confirmed in a letter to all NHS bodies in July.

In that letter Sir Simon Stevens asked that all ICSs ‘embed and accelerate joint working through a development plan’, which includes ‘a single STP/ICS leader and a non- executive chair’ and ‘clearly defined arrangements for provider collaboration’.

The commercial restraints on commissioners are also expected to ease. The Long Term plan proposes to repeal procurement rules from the 2012 Health and Social Care Act to ‘free up NHS commissioners to decide the circumstances in which they should use procurement, subject to a ‘best value’ test’.

On the ground, we are already seeing commissioners seeking to streamline relationships with providers, demand fewer, bigger contracts, and focus on the whole population rather than smaller footprints that many providers are used to.

Everything points toward a future firmly about collaboration over a wider population. Sticking to your patch is becoming a less viable option. This provides both a challenge to how NHS organisations think about themselves, and an opportunity to do things differently.

The new system-level focus requires collaboration across traditional organisation boundaries. For NHS community trusts this means working together with their neighbours to cover whole systems.

What form collaboration takes is up for grabs. It will not be easy. We are working with trusts to explore a range of options from Contractual Joint Venture Agreements, to partnership agreements with the establishment of single governance structures across multiple organisations. As part of these, former rivals need to become bosom buddies, or risk their services being eroded as contracts shift to the system level.

What benefits can these structures bring? They can preserve local knowledge, relationships and good practice by protecting organisational cultures, whilst increasing innovation by encouraging the workforce to collaborate across organisational boundaries. They can reduce variation and duplication through the development of seamless pathways – leading to improved outcomes, reduced health inequalities and better patient experience.

Acting now means community trusts can be the architects of their own destinies. This includes seeing off the risk of acquisition from the behemoths of the acute sector. Commissioners need to be watchful here too and ask themselves ‘would handing more services to acute providers really deliver on the stated intentions of the Long Term Plan?’

This is a pivotal time for the NHS and what happens in the coming year will shape the health services for a generation. Integration a non-negotiable but how organisations go about it, at least at the moment, is largely up to them.

COVID-19 has shown the critical importance of high quality, joined up community services. The leaders of these services now have an opportunity to place themselves at the centre of local plans and show the rest of the NHS how integration is done.

To hear more about our work in community services and to speak to us about we could help you, contact matt.carter@mutualventures.co.uk.

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