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Six months on from the launch of ICS, and…

By freelance social care writer Eleanore Robinson

In July 42 Integrated Care Systems (ICS) launched with the aim of joining up health and social care systems to provide more seamless services.

Almost six months on, however, social care providers are finding it hard to get involved with these new bodies, set up to replace CCGs, which are now responsible for planning and commissioning publicly-funded social care services.

Nathan Jones, senior policy, research and projects officer at the National Care Forum, said: “Our members are finding it incredibly difficult to engage with the ICS at system-level at the top level.

“What our providers find is where they had good relationships with the local authority and health board commissioners before the ICS went live, they got more involvement.’

“We do have a few members who have actively tried to engage at system-level and above and just can’t.”

Jones added that lot of providers were engaged at place level.

More take than give
Chief executive of Care England Professor Martin Green said the issue was that when the ICS reach out to social care it is “on the basis of what it can do for the NHS”.

He said: “There is very little change going to happen because the ICS culture is totally NHS focused and dominated.

“We have had some good contact but it is very much a patchy picture. When you think about how many there are, the number who have engaged with social care is very few.”

Jones argued that one problem was social care not having a statutory voice on the Integrated Care Board. “That is a real barrier to the collaborative approach”, he said.

He explained that in some areas, commissioners think local authority representation is sufficient to give social care a voice. In others there is a mentality of keeping a distance between the commissioner and provider.

Jones added: “Many of our members would give good insights into how to make discharges work better and how you could prevent admission in the first place, but they don’t get listened to.”

“It is the problem of having a very powerful partner, one institution, versus social care which is very fragmented.”

Commissioning concerns
The commissioning power of the new ICSs is also a concern for some providers. Sanjeev Kanoria, founder and chairman of Advinia Health Care, said: “Integrated health and social care is a very good idea. It prevents bed blocking and allows for faster movement of patients in hospitals into social care settings.”

On the converse side, he wonders what will happen when they have more market power. He says: “If you have one market player, you contravene all principles of market dynamics. That is a big risk.”

Kanoria said measures should be put in place by the Government so that the ICS wield their power in the right way.

Professor Green added that the ICS should have been set up with requirements to include social care in the planning process and the development of services process.

“Social care has been trying to get a voice but, frankly, I can’t believe that a government that is supposed to be focusing on integration would make the same mistakes that have been made with PCTs, CCGs, health and wellbeing boards.”

In addition, many people in the ICS were previously employed in PCTs and CCGs, causing concerns that an NHS mentality will continue to pervade.

The National Care Forum has been working with NHSE and DHSC to start the process of creating routes into the ICS for social care.

They are looking at how to make social care an active part of the system, Jones said. Ideally, this would involve people who have social care knowledge on the Integrated Care Boards as well as in the Integrated Care Partnership.

But, he said: “How do you force the culture change when there is no mandatory representation?


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