Organisation objective
- NHS Mandate from Government
- NHS Long Term Plan
Action required
The Board is asked to note the information provided in the paper.
Summary
1. The strategic direction for integration has been developed in a number of publications including the Long Term Plan and the Fuller Stocktake. Recent commitments by the new government demonstrate further support for this direction of travel.
2. Kevin Lavery, Chief Executive, and Dr Andy Knox, Associate Medical Director/Population Health from NHS Lancashire and South Cumbria (LSC) Integrated Care Board (ICB) will present the opportunities and challenges in LSC and the approach they have taken to support proactive care and population health management in an integrated way.
Strategic direction
3. Recent strategy for the NHS has focused on integration. This was highlighted by The Long Term Plan, which committed to boost ‘out-of-hospital’ care and dissolve the historic divide between primary and community health services. This was subsequently built on by the Fuller stocktake, which outlined the approach to accelerating the implementation of integrated primary care.
4. We now also have the commitment from the government to three strategic shifts for the NHS, which are:
- hospital to primary care and community services
- analogue to digital
- treatment to prevention.
5. The government has also committed to the development of a Neighbourhood Health Service, with more care delivered in local communities, supported by a shift in resources. The recent report by Lord Darzi has also supported this strategic direction, highlighting that a more joined-up approach and transformation shift is required to resolve the current fragmented model.
6. We know that joined up health and social care leads to better outcomes for people. When local partners including the NHS, councils, voluntary sector and others work together, they can create better services based on local need. This single team approach better allows for the identification, support and management of people’s health needs, and supports a focus on narrowing health inequalities and improving outcomes for our most deprived populations.
7. Investing in preventative care also provides greater opportunities to treat patients earlier in the pathway, reducing the likelihood that they will become acutely unwell, which also protects capacity in acute hospitals for those who need it most.
8. We also know that continuity of care is important, particularly for people with long term conditions or complex care needs. People should be supported and treated at home where this is appropriate, or as close to home as possible. Improved coordination of care and improved access to specialist and urgent care in the community is also vital to avoid unnecessary attendance or admission to hospital.
Approach to integration locally
9. Much of this approach is not new, and the strategic direction described above is already happening across the country, with many examples of places that are innovating and are delivering examples of the integrated vision.
10. We are continuing to learn about approaches to integration in local areas, including the barriers and enablers to implementation, and different types and scale of approaches.
11. At a national level we need to ensure we are taking the right steps to support local areas to embed the ways of working to support these strategic shifts, building on the recommendations from the Fuller Stocktake, and learning from approaches which are being piloted, such as the primary care network test sites.
NHS Lancashire and South Cumbria ICB
12. NHS Lancashire and South Cumbria (LSC) has a mixture of affluent areas and severe pockets of deprivation, and a history of poor performance and deficits within the acute trusts. Deep-seated poorer health outcomes and inequalities are the reality, yet at the same time there are plenty of opportunities to live within the budget and make progress. Blackpool is LSC’s most challenged geography, with male average life expectancy at 69 years (10 years below England average) and female average life expectancy at 74 years (9 years below England average), and a challenged hospital trust and small unitary council.
13. Currently, LSC has eight medium-sized hospitals and there are opportunities for clinical reconfiguration, back-office consolidation, and the implementation of an electronic patient record across LSC. There is also the opportunity to shift from an ‘acute-centric’ to a ‘community-centric’ system. This shift will include several key elements, including taking long term condition management out of acute care and reducing admissions to emergency departments by targeting support at high-risk groups, including the frail elderly and most deprived populations. It is worth noting that within Blackpool, healthy life expectancy is 46.5 years, which means that the frail population often includes people who are not elderly.
14. In Blackpool, the leadership arrangement for place was set up as a joint appointment with Blackpool Council. Karen Smith is both the director of adult services at the council and Blackpool’s director of health and care integration. There are five priority wards in Blackpool; Bloomfield, Claremont, Park, Talbot and Tyldesley. LSC’s population health team focuses on reducing unplanned hospitalisations for health conditions where earlier proactive support can reduce the impact of the condition on a person’s life. This has involved a deep dive of local data and working with voluntary, community, faith and social enterprise (VCFSE) partners. This work has identified that the main reason for unplanned hospitalisation is due to complications related to COPD and asthma. Work is now ongoing across partners to identify social determinants of health and support action on these, alongside providing NHS resources “upstream” to provide earlier support. Plans also include investment in lived experience and community champions, and continuing to work closely with communities to understand their needs.
15. The opportunity to improve the health and wellbeing of LSC and reduce health inequalities is twofold. Firstly, to work at a neighbourhood and place level to identify local needs down to specific wards, and work closely with community organisations to respond to place-specific needs. Secondly, to transform LSC over the next ten years into a community-centric health and care system. These are ambitious plans, but they present a significant opportunity with the support of LSC’s communities, partners and NHS leadership at all levels.
Points for discussion
16. What can we learn from the approach taken in NHS Lancashire and South Cumbria ICB?
17. What needs to happen nationally and locally to support the three strategic shifts as set out above?
Publication reference: public board paper (BM/24/36(Pu))