The Norfolk example suggests that integrated care systems can work if partners value their common goals, writes the chief executive of Great Yarmouth BC.
If there was any doubt about the benefits of collaboration between the health service and local authorities, the Covid-19 pandemic put an end to that.
With reduced capacity due to tighter infection control measures, getting people out of hospital and into social care was a crucial factor in maintaining the health service and free beds for those in need. urgent and vital care.
At the other end of the equation, District and Borough Councils like ours in Great Yarmouth have become the pointed end of public health like never before, with rapidly recruited Covid Marshals supporting the public and responding quickly to outbreaks, our environmental health team verifying compliance with lockdowns and the multitude of related trade restrictions, and our community networks coming into their own to encourage vaccination.
Our Community Champions program has been invaluable in increasing immunization rates. This network of volunteers from across the community served as a link between NHS and public health experts and our residents, sharing information back and forth. It helped us get into “hard to reach” groups or, as one representative told us so eloquently, “We’re not hard to reach, we’re waiting here”.
What does this have to do with integrated care systems?
The work done by our Champions and Marshals has resulted in a measurable difference in vaccination rates in the areas where we have worked compared to similar demographics elsewhere in Norfolk.
It showed the power of our collaboration and, just as importantly, it helped create links and better understanding between counselling, primary care, community health, social care and acute health services. We all know each other better.
As part of the development of our ICS, Norfolk councils, including Great Yarmouth, have already had the chance to be part of NHS England’s Health Equality Partnerships and NHS Improvement system leadership programme. This has allowed us to work with other clinical commissioning groups to share best practices and learn what each partner brings to the system as a whole.
This work has highlighted important principles for partners to consider at the “place” level, as we build on existing agreements.
Governance arrangements should develop over time, with the possibility of more formal arrangements as trust grows
One of the key takeaways is that there is no one-size-fits-all approach to defining how or at what scale partners should come together to work in an ICS. The beauty of ‘local work’ is that it reflects locality and will mean different things across the country. Existing arrangements do not always match across administrative borders: our ICS stretches from Norfolk to Suffolk, with our local acute care hospital caring for people on both sides of the border. Place-based partnerships should start by understanding people and communities and agreeing on a common goal before defining structures.
Effective partnerships are often built “by doing” – by acting together and establishing collaborative agreements to support that action as it evolves. We have seen it in extreme form during the pandemic. This pace isn’t sustainable in the long term — nor is the emergency funding that comes with it — but it shows potential, and it’s also helped us discover what isn’t working.
Trust leads to better relationships
Governance agreements should develop over time, with the potential to evolve into more formal agreements as working relationships and trust grow. One might wonder who holds the purse strings or sets the strategy. In Norfolk, we are considering cross-appointments in some key positions and looking at how our existing community councils do or do not fit into the ICS in the future. We have to be creative about the right approaches, but the most important thing is to understand common goals. This builds partnerships on an ethic of equality between sectors, organisations, professionals and communities.
Partners should reflect on how they develop the culture and behaviors that reflect their shared values and nurture open, respectful and trusting working relationships, supported by clearly defined mechanisms to support public accountability and transparency.
In Norfolk, it is well recognized that connecting borough councils with our residents and their communities, and indeed with our business community, means that we have a unique community leadership role which can really benefit the new model of ICS work – both at ward level (based on primary care levels) and on site (in our case Great Yarmouth and Waveney).
Over the past few years, we have developed a clear locality strategy alongside local and central government, police, education providers and the wider voluntary sector, which has enabled us to identify and agree of four thematic priorities. We are already working towards these shared goals, and our joint approach helps us put the needs of residents first.
It’s not something we start from scratch. Instead, we are transforming what already exists in the world of health and care. It’s an organizational strength that makes us natural leaders and collaborators on our board and in developing our health and wellness partnerships. Their success will then allow power and funding – and more importantly improvements on the ground – to follow. The proof of the effectiveness of the place board remains to be seen but we are optimistic for the future.
Sheila Oxtoby, General Manager, Great Yarmouth BC