Delivering Integrated Care in Cheshire and Merseyside

  1. Shared vision

Our vision, as described in our ICS strategy, is for everyone in Cheshire and Merseyside to have a great start in life, and get the support they need to stay healthy and live longer.

We will do this by working together, as equal partners, to tackle health inequalities and improve the lives of the poorest fastest.

Joining up health and care is nothing new – we have been working towards this for some years, and we want to continue build on this excellent work. This includes further strengthening the incredible joint working we have seen throughout the Covid-19 pandemic, which has made a massive difference to the lives of local people and their families.

  1. Strategic Objectives

We have four key strategic objectives.

  1. Improve population health and healthcare
  2. Tackle health inequality, improving outcomes and access to services
  3. Enhancing quality, productivity and value for money
  4. Helping the NHS to support broader social and economic development 
  1. What this means for people and communities

We all want the very best health and wellbeing for our families, friends, communities and for ourselves. And when we need to access health and care services, we want these to provide us with the best care and the best outcomes.

Prior to the Coronavirus Pandemic, we engaged extensively across our partnership to understand the key health and wellbeing issues for our people and communities.

This engagement reinforced that we need to address several significant and well documented challenges. These are not unique to Cheshire and Merseyside, although some problems are worse for us locally. 

Stroke, suicide, alcohol related harm and death from violent crime were all identified for targeted whole system action, together with better access to services in deprived communities.

To achieve our vision, we will need to make some tough decisions. But we must be resolute in our ambition to collaborate to deliver improved health and wellbeing of the 2.5m people of all ages living across our communities.

We have seen that it can be done. Throughout the pandemic, a shared purpose has enabled us all to fully appreciate each partner’s contribution. It’s vital to build on this as we consider our future ways of working.

  1. National context

The new Health and Care Bill sets out legislative changes required to change to enable health and care to work more closely together.

In Cheshire and Merseyside, it has long been our ambition to improve the way services work together, but bureaucracy has often made this challenging. The reforms therefore support us locally by removing some of the legal rules that can get in the way of truly joining up care.

A duty to collaborate will be created to promote joint working across healthcare, public health, and social care. The duty will apply to both NHS organisations and local authorities. There will also be a focus on removing the legislation that hinders collaboration and joint decision-making.

In effect, the reforms give us the opportunity to make our vision a reality. However, while legislation can help to create the right conditions, it will be our hard work that will make the biggest difference.

A shared duty to have regard for the ‘triple aim’ of better health and wellbeing for everyone, better care for all people and sustainable use of NHS resources is the key driver

2.0 What will be different?

There is a lot of new terminology related to the reforms set out by the Health and Care Bill. Some of key terminology is explained below.

Integrated Care Systems (ICS)

An Integrated Care System (ICS) brings together the NHS organisations, councils, and wider partners in a defined geographical area to deliver more joined up approaches to improving health & care outcomes. 

There are 42 ICSs in England, including Cheshire and Merseyside, which is the second largest in the Country.

From April 2022 the Cheshire and Merseyside ICS will have legal status and will include a statutory Integrated Care Partnership (ICP), and a new NHS body called the Integrated Care Board (ICB). These are described in more detail below.

Integrated Care Board (ICB)

Integrated Care Boards (ICBs) will be established as new statutory organisations to lead integration within the NHS. The Cheshire and Merseyside ICB will have a unitary board and minimum requirements for board membership will be set in legislation. 

The Integrated Care Board will be responsible for the day-to-day running of the NHS in Cheshire and Merseyside, including planning and buying healthcare services.

The current functions of Cheshire and Merseyside’s 9 clinical commissioning groups (CCGs) will be transferred to the Integrated Care Board by April 2022, following their closure.

Integrated Care Partnership (ICP)

The Integrated Care Partnership will provide a forum for NHS leaders and local authorities (LAs) to come together, as equal partners, alongside important stakeholders from across Cheshire and Merseyside.

Together, the ICP will generate an integrated care strategy to improve health and care outcomes and experiences for the people in Cheshire and Merseyside, for which all partners will be accountable.

The ICP will be a dedicated forum to enhance relationships between the leaders across the health and care system, interact with and support the development of Place-Based Partnerships.

Place-Based Partnerships

The Cheshire and Merseyside ICB will arrange for some of its functions to be delivered, and decisions about NHS funding to be made, in the region’s 9 borough places – through Place-Based Partnerships.

The ICB will remain accountable for NHS resources deployed at borough place-level.  Each ICB will set out the role of designated Place-based leaders within its governance arrangements.

Health and wellbeing boards (HWBs) will continue to develop the joint strategic needs assessment and joint health and wellbeing strategy, which both the ICP and ICB will give due regard.

Provider Collaboratives

Providers of health, care and support services will increasingly collaborate at all levels of the system. This is nothing new; there are some great examples of joined-up provider working, especially during the Covid pandemic. However, the current rules don’t always encourage provider collaboration.

There are two separate Provider Collaboratives for Cheshire & Merseyside.

Both will agree specific objectives with the ICB, to contribute to the delivery of Cheshire and Merseyside’s strategic priorities and are committed to working together to support the delivery of benefits of scale and mutual aid across multiple places or systems.

2.1 What are the benefits of these reforms?

The reforms will seeindividual organisations in Cheshire and Merseyside better supported by each other and the system through cooperation and collaboration.

The opportunity to increase efficiency and reduce duplication will lead to higher quality, more sustainable services.

Decisions will be taken closer to the communities they affect, leading to better outcomes. There will be a better use of community assets and a greater focus on prevention and wellbeing.

There are huge benefits for people and communities of having integrated care in their neighbourhoods by joining up primary, community, social care, and wellbeing services.

2.2 Involving people and communities

There are ten principles that underpin how the Cheshire and Merseyside ICS will work with people and communities. We will:

  1. Put the voices of people and communities at the centre of decision-making and governance, at every level of the ICS.
  2. Start engagement early when developing plans and feed back to people and communities how their engagement has influenced activities and decisions.
  3. Understand your community’s needs, experience and aspirations for health and care, using engagement to find out if change is having the desired effect.
  4. Build relationships with excluded groups, especially those affected by inequalities.
  5. Work with Healthwatch and the voluntary, community and social enterprise (VCSE) sector as key partners.
  6. Provide clear and accessible public information about vision, plans and progress, to build understanding and trust.
  7. Use community development approaches that empower people and communities, making connections to social action.
  8. Use co-production, insight and engagement to achieve accountable health and care services.
  9. Co-produce and redesign services and tackle system priorities in partnership with people and communities.
  10. Learn from what works and build on the assets of all ICS partners – networks, relationships, activity in local places.

2.3 Involving and supporting our staff

Our staff are our greatest asset. Our ambition is a ‘one team’ approach, which for our staff will mean.

  • New ways of working that better meet the needs of local people.
  • Working collaboratively will create new and flexible roles, with development opportunities for staff and increased job satisfaction.
  • Health and care professionals will have more time to spend with people who need their help.
  • Having a greater impact on the health and wellbeing of our communities and a reduced level of bureaucracy will create a happier workforce with greater levels of purpose and job satisfaction.
  • Shared records and increased data sharing (another change outlined in the White Paper which will make joined-up working easier) will allow more timely access to patient information.
  • There will be improved communication between staff across all parts of the C&M system.
  • New technology and improved communication between services will make working lives easier and more efficient.

We want to reassure colleagues who are directly affected by organisational change that we place a huge importance on retaining the wealth of talent, skills and capabilities in Cheshire and Merseyide. NHS England and NHS Improvement has made a commitment of continued employment for CCG staff and national HR guidance has been published here.

Once legislative changes have been agreed in Parliament, there will be a formal, open, and transparent staff consultation process.

We will make sure partners are informed about any developments as early as possible and will ensure that arrangements for support are in place for staff directly affected by organisational change.

2.4 Published Guidance

NHS England and Improvement continues to publish guidance documents setting out how NHS leaders and organisations should operate with their partners in Integrated Care Systems (ICSs) from April 2022.

Up to date guidance can be viewed at https://www.england.nhs.uk/publication/integrated-care-systems-guidance/