New NHS framework to measure and align ICS performance
A recently released framework has revealed how NHS England plans to measure ICS performance, whilst reinforcing the approach for progressing system-led delivery of integrated care.
The NHS System Oversight Framework is built around five national themes that reflect the ambitions of the NHS Long Term Plan and apply across trusts, commissioners and ICSs. These are:
- Quality of care, access and outcomes;
- Preventing ill health and reducing inequalities;
- Finance and use of resources; and
- Leadership and capability.
A single set of metrics across ICSs, trusts, clinical commissioning groups (CCGs) and primary care, will be aligned to these five national themes, whilst a sixth theme, local strategic priorities, recognises that ICSs each face a unique set of circumstances and challenges in addressing the priorities for the NHS in 2021/22
The framework details that an ongoing cycle will be followed to measure performance, consisting of:
- Monitoring ICS and NHS organisation performance and capability under the six themes
- Identifying the scale and nature of any support needs
- Co-ordinating support activity, and where necessary, formal intervention.
Where systems are deemed to need the highest levels of support activity, they may be added into the new national Recovery Support Programme (RSP). This will provide focused and integrated support, working in a co-ordinated way across the system, regional and national NHSE/I teams to make more intensive improvements.
The intention in creating the framework is to set out NHSE/I’s headline ambitions for how they will ask NHS leaders and organisations to operate with their partners in ICSs from April 2022, whilst detailing how they will support and be involved in this process. It is expected to be enabled by legislation in due course.
In support of the Framework’s ‘People’ theme, Liaison Workforce are happy to discuss suitable and innovative solutions for making workforce improvements across trusts, regions and systems. To find out more, please get in touch at email@example.com
Three tiers of support coming for ICS procurement processes
The HSJ has reported that NHS England will intervene to provide support to systems needing to upgrade their procurement functions to meet new operating standards.
Regional NHS procurement teams are in the early stages of transforming how they buy non-NHS goods and services, worth around £17bn each year. This is part of a move towards more system-level working, and away from single-organisation procurement teams.
However, an internal NHS England briefing document seen by the HSJ, dated 23 June, suggests many systems are struggling to make key changes. It states: “The scale and complexity of the change required for ICS procurement collaboration is asking a lot of the current provider landscape”.
Noting that a number of ICSs have requested guidance in transforming their approaches, NHSE/I is apparently planning to propose three tiers of engagement, with varying degrees of involvement based on factors including “level of maturity/readiness, historic engagement with NHSE/I, [and] specific support requested”.
The least mature systems will have “extensive” engagement support, including “ongoing project planning and implementation support”, whilst the top tier will be “light-touch” and involve “self-reported progress… against key activities”.
With only a small number of ICSs currently having a dedicated procurement lead appointed, additional guidance and support from NHSE/I may be an essential stepping stone in supporting non-NHS procurement activity during the transition to system working.
How virtual wards assist with admission avoidance
Avoiding admission into hospital wherever safe and possible is not only in the interest of an NHS organisation, but in the ongoing pandemic, many patients also wish to avoid a hospital setting as much as possible, thus reducing their personal risk of catching Covid-19.
Virtual wards allow ongoing care to be provided to those who need it in the community – usually at home or in a care home. They align with the working aims of ICSs of collaborative working across health and social care, and virtual wards have greatly assisted the NHS’s pandemic efforts in supporting non-critical Covid patients to be supported in their recovery at home.
As ongoing waves of Covid-19 continue to threaten to overwhelm NHS organisations, the use of virtual wards has become a vital tool in avoiding preventable hospital admission. However, in order to ensure seamless, joined up care outside of the hospital setting, medical teams require coordinated task management that works across different technology systems.
mii Tasks, delivered by Infinity Health, joins up the processes so that task management is more fluid, enabling multidisciplinary teams caring for the same patient to have visibility of the activity of the team and the status of clinical tasks in real time. For example, a patient who is recovering from Covid-19 could go home earlier to continue their recuperation and may submit readings (e.g. for oxygen levels) remotely on remote monitoring tools for their clinical team to check and assess. Through task management these readings could not only be visible to the relevant staff but could also instigate tasks to be actioned. At the same time, a physiotherapist could treat the patient at home, logging when they visit, what they did, and adding to the required task list for the patient. Teams would not necessarily have to work for the same organisation (providing the right data-sharing agreements were in place), and yet seamless care could continue to be provided effectively.
Where NHS organisations have the solution in place to join up disparate technology systems, care coordination becomes more effective, and much needed beds are released within hospitals to counter the risk of becoming overwhelmed – providing not only a short-term solution to ongoing Covid-19 efforts, but a longer-term process for avoiding unnecessary admission whilst advancing quality of care.
To find out more, please get in touch at firstname.lastname@example.org
Dismay at lack of change to some ICS boundaries
Earlier this year, whilst still in position as Secretary of State for Health and Social Care, Matt Hancock asked NHS England to review all ICS boundaries where they did not align with upper-tier local council areas. In July, and with Sajid Javid now in the role of Health Secretary, it has been announced that this will not go ahead, with only six ICSs subject to having their boundaries changed.
It is likely that many in local government in particular will be disappointed by this development, stating that having the ICSs not coterminous with local authority regions risks future difficulties for funding and collaboration.
NHS Confederation ICS Network Lead, Lou Patten, said: “We need to ensure that those affected systems are supported to make these changes and develop their new partnerships in time for their statutory responsibilities in April 2022, which all comes at a time of immense operational pressure.”
Guidance has not yet been released advising when ICSs will be expected to change their boundaries or how this process will be managed and implemented.
Liaison Group’s Chief Executive Officer, Andrew Armitage, says: “We are getting closer to the operational date for ICSs in England, of April 2022, and late changes in boundaries and system partners will make the transition increasingly difficult. We hope that some stability can be reached to allow for the set up to proceed as smoothly as possible, whilst allowing for patient care to be largely unaffected except for the better.
“If any ICS would like support in implementing tools or technologies to support operational effectiveness as their ICS takes shape, we would be happy to offer our expertise to work out valuable solutions.”
To find out more, or to open your ICSs conversation, please get in touch at email@example.com
Public Accounts Committee Calls for Government Action on NHS Workforce
The Public Accounts Committee has called on the Government to do more to support the health and social care workforce to ensure its resilience going forward. The recommendation has come as part of a report into the government’s response to the Covid-19 pandemic.
In the report, the Committee has raised a number of concerns with how the government has tackled Covid-19. On workforce, the report notes that the NHS was carrying 40,000 nursing vacancies and 9,000 medical staff vacancies going into the pandemic and that as of last September, over a third of nurses were considering leaving the health service. It has said that the government cannot wait for its inquiry into the pandemic to learn important lessons.
The report states: “The pandemic has compounded pre-existing challenges in the health and social care sectors… Longstanding staffing issues and backlogs, arising from failures in workforce planning and recruitment, have exacerbated the impact of the pandemic not only on the public, but also on the health workforce. NHS and frontline workers, already under pressure before the pandemic, have had to deal with the mental and physical strain of the response and are now tackling backlogs whilst carrying high numbers of vacancies.
“The NHS estimated in December 2020 that it had nearly 89,000 full-time equivalent vacancies across secondary care settings in England. We are concerned about the impact of the pandemic on the mental health of key workers and burnout levels, which may result in more individuals leaving the medical profession and even higher vacancies rates going forward. This makes the publication of the long overdue NHS People Plan even more urgent.”
The Committee has recommended that:
The Department for Health and Social Care should write to the Committee by November setting out what it is doing to provide support to NHS staff, what metrics it is using to track the effectiveness of the measures adopted, and how it is performing against those metrics.
By the end of the year, DHSC should write to the Committee to provide an update on the substantive long-term NHS workforce plan to ensure the resilience of the health and social care workforce.
Liaison Workforce Commercial Director, Laurence Ansell, responds: “It is important that the government is held to account in their handling of the Covid-19 pandemic, but with vacancies increasing all the time across the NHS, a robust strategy for improving the wellbeing of those staff still in place is essential to slow the tide.
“Staff wellbeing should be at the forefront of all Trust workforce strategies, and we would be happy to discuss possible solutions from our mii Platform to help achieve objectives of staff retention and improving wellbeing levels. From improving the user experience for rostering to providing essential tools for flexible working to promote better work/life balance, all of the solutions from the mii Platform have been developed with the end user in mind, the staff, in order to make their working lives easier.”
In Conversation With… Eve Russell: Progress and Recovery – A People Plan Review
The latest episode of Liaison Workforce’s In Conversation With series sees Eve Russell, Head of Transformation at NHSE/I South West, reflecting on the progress that has been made since the implementation of the NHS People Plan with Liaison Workforce’s Ed Leonardo.
Despite the impact of Covid-19, Eve and Ed look at the Plan’s main achievements to date, how we hold on to the progress that has been made, and discuss what more needs to be done and what NHS organisations should look to focus on as part of their Covid recovery plans.
Join the conversation here.
A brief look at the benefits of delivering CHC at ICS level
Across England, most Continuing Healthcare (CHC) has historically been delivered with a local team, at CCG level. But as CCGs amalgamate into bigger entities, and the NHS evolves, should this delivery be moved to system-level, and what would the benefits be?
A single operating model operating across an ICS would provide the opportunity to move towards a consistent approach for CHC decision-making and delivery, across a much larger geography, thereby reducing unwarranted variation.
It could also provide several additional benefits, such as the opportunity for a number of specialist roles which are often not viable for individual CCG CHC teams, for example, those supporting children’s services. It may be possible to share resources better across a wider footprint, and with the increasing workload from the new Discharge to Assess requirements, there are likely to be different pressure points in different localities at different times.
System-led delivery could allow an opportunity to harmonise, and in some cases modernise, the back-office function, with potentially greater investment available for more efficient use of technology, reduced handovers, and significantly improved data quality.
Liaison Care has recently been appointed by one ICS to deliver a quality review in real time for all of their CCGs. The work will allow us to confirm if the decisions made by the various CCGs are supported by the paperwork they are reviewing, how well they would stand up to appeal, what level of uniformity there is across the CCGs around decisions, and what potential there is to better control overall CHC spend. The aim will be to ensure uniformity in CHC decision-making so that patients receive a consistent and fair service across the entire system. That should see us helping to improve local decisions, whilst reassuring the ICS that it has the uniformity it is seeking.
And if all of these benefits could be realised without losing that vital ‘place-based’ support to local communities, then, as they say, ‘we could really be on to something’.
To find out whether a Liaison Care quality review could benefit your ICS, please get in touch at firstname.lastname@example.org
News & Views
- Sir Chris Ham, Chair of Coventry and Warwickshire ICS, has written in the HSJ of the importance of combining the software of relationships with the hardware of governance. Read more.
- In a new HFMA blog, Claire Yarwood, Chief Finance Officer at Manchester Health and Care Commissioning, considers what financial ICS priorities should be. Read more.
- A number of ICS boundaries are to change. Read more.