By Cllr David Hare
The NHS has changed again, a new governance is being worked out.
There are, on paper, some positive moves but whether what is expected occurs is another question.
In theory at least, all Councils will now have an important position within the new Integrated Care System (ICS). Integrated care systems (ICS) are partnerships of organisations that come together to plan and deliver joined-up health and care services and to improve the lives of people who live and work in their area.
Wokingham is in the Buckinghamshire, Oxfordshire and Berkshire West (BOB) ICS.
The structure of this is headed by the top-level (NHS-led) Integrated care board (ICB), which is responsible for developing a plan for arranging for the provision of health services in the ICS area.
Below that is the Integrated care partnership (ICP), this is where Local Authorities come in.
The ICP is jointly formed between the NHS integrated Care Board Chair and all upper-tier local authorities that fall within the ICS area. It is concerned with improving the care, health and wellbeing of the population.
As now Local authorities in the ICS area are responsible for social care and public health functions, this should bring a continuum of care.
The lowest denominator are Place-based partnerships that will lead the detailed design and delivery of integrated services across their localities. These partnerships will involve the NHS, local councils, community and voluntary organisations, everyone with a role in supporting the health and wellbeing of the population, being practical outworking of strategy.
The problem we have in Wokingham is that Wokingham is joined with West Berkshire and Reading in Berkshire West Place.
We all know Wokingham is healthy and wealthy, but we still have real poverty and disability in our Borough, this needs support.
Because of our general healthy position Wokingham usually loses out in the allocation of funds, so people who deserve support lose out because of the postcode lottery. Additionally, the Place is meant to work with the Wellbeing boards of the Local Authorities, but in West Berkshire place there are three Wellbeing boards, with differing priorities and expectations.
The proposals for the ICS represent a marked shift away from the focus on competition of the last reorganisation.
They move towards a model of partnership; a model being forged at Wokingham Council in many areas.
In theory, this gives greater flexibility to deliver joined-up care to the increasing number of people who rely on multiple services. But it is not possible to legislate for collaboration and co-operation.
This development of working together requires sometimes radicle changes to the behaviours, attitudes and relationships of staff and leaders right across the health system. In BOB ICS it did not appear that this changed mindset had been appreciated by senior management, but things seem to be changing and we can only hope for a strong voice at the NHS table.
The purpose of ICS’s is said to be to bring partner organisations together to:
Improve outcomes in population health and healthcare
Tackle inequalities in outcomes, experience and access
Enhance productivity and value for money
Help the NHS support broader social and economic development.
I believe is the most important thing the ICS brings is helping the NHS to recognise the very important place Local Authorities play in the health economy.
Wokingham Adult Care seeks to Prevent, Delay and Reduce the NHS need for input with all our residents.
In Wokingham, we already have a Wokingham Integrated Partnership (WIP) that I chair. This works jointly with the NHS and voluntary system to put in place local ideas that often have a large effect on people’s wellbeing, keeping them away from the need for NHS intervention. This includes things such as the MIND wellbeing service, a Mental Health primary service initiated by Wokingham and proving very successful.
We also look at things such as Winter pressures, with vaccination, self-care, discharge pressures and admission avoidance.
Another problem here is with discharge pressures as in the pandemic Wokingham was found extra money from the NHS to get people out of hospital as fast as possible. The expectation to get people out has not dropped, but there is now no specific funding to do this, it is expected to be found from a very tight Adult Care budget where there is no spare money available.
WIP covers at least 17 schemes that include the Friendship Alliance, Home from Hospital, Care Home support and the Intermediate Care Team (Health reablement), all services supporting and enabling the people of Wokingham, cutting NHS costs.
Wokingham is working as well as possible with the NHS, despite the fact that we believe significant additional investment is required for the funding of care that should have been provided by the NHS where Wokingham Adult Care has filled in.
The new Integrated Care System (ICS) promises potentially a better working relationship between Adult Care in all Local Authorities and the NHS. To get where it is intended to land first of all Care Workers pay must be increased substantially.
Equivalent NHS pay scales are about 30% higher than Care workers, something must be done. This whole scenario is about equality between Adult Care and the NHS.
Without doubt, it will require a fundamental change in the way Adult Care is viewed by the NHS if it is to be the success it could be, serving the population of Wokingham with cost effective, integrated care.
Cllr David Hare is the member for Hawkedon Ward, and executive member for Adult Services on Wokingham Borough Council
