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8 February 2018 in London sees the third annual joint CIPFA/HFMA Summit on Integration. Can there be much left to say? It turns out that there is, because the issues are complex, experience moves on, and the circumstances in which integration is to be progressed keep changing.
Compared with this time last year, intentions have been clarified through the publication of Next Steps on the 'NHS Five Year Forward View', which sets out how sustainability and transformation plans (STPs) should migrate over time towards 'accountable care systems' (ACSs). There is a clear emphasis on collaboration and whole system working in contrast to the previous emphasis on competition as a means of driving organisationally based improvement. This implies a dismantling of the purchaser provider split in the NHS – in functional practice, if not in formal structures, as no one has much appetite for structural reorganisation. The updated plan can be taken to have filled in what was, this time last year, something of a gap between the government’s expressed intention to achieve full integration by 2020 and the absence of any obvious route map for getting there.
So far, so straightforward, you might think – but that still leaves the matters of how ACSs should best operate, and how to get to a system which is meaningfully driven by population health. That’s not so easy, especially in straitened financial circumstances which made it very hard to invest up front for preventative purposes or to fund transitional costs such as double-running old and new approaches. It’s timely, then, for the Summit to consider the developing options in practice.
A salutary starting point, with Suzanne Tracey as chair, will be provided by considering integration from the perspective of those for whom health and social care is, after all, set up – the patient/customer. Jeremy Taylor (CEO, National Voices) will explain. John Rouse from Greater Manchester and Mark Webb from North East Lincolnshire will provide views from two of the areas seen as having moved furthest towards working as a single system. Further perspectives will be added from Wales – which has an interestingly different setup from England’s or Scotland’s – and from Camden, with an emphasis on the role of IT.
And if the main benefit of getting the collaborative aspects of integration working as well as possible is to put local systems in a better position to transform services in ways which improve their quality and cost effectiveness, then a key example is provided by the recent interest in social prescribing. The National Clinical Champion for social prescribing (Dr Michael Dixon, from NHS England) and a lead programme manager of a local scheme now up and running (Sian Brand from Mid Essex) will combine to explain the potential of this development.
Mark Rogers, whose wide experience includes leading one of the biggest STPs in the country, in Birmingham, will pull together the threads in the closing keynote address. Overall, the day should help set out how we can make a reality of the widely shared aim of moving to whole system working driven by population health.