Integrated Care Systems - The Why, How and What of Multi-Purpose Design

Integrated Care Systems: the why, how and what of multi-purpose design

Alastair Mitchell-Baker continues our series on the development of integrated care in England. With the government introducing legislation, we are exploring different aspects of ICS development over the coming months – sharing evidence, experience, insights and views from a range of guest contributors and our team. This week Alastair explores designing ICSs – for multiple purposes.

To read other blog posts within this series, click on the link below.

In my last blog, I discussed the importance of building shared understanding and clarity of purpose (why) as a critical building block for the new Statutory ICSs. Given the inherent tensions within the purposes of ICSs, this needs careful handling and convening of system partners who will in turn have different emphases.

As partners craft core purpose(s) and ‘shared meaning’ together they can begin the critical phase of designing the new ICS, and system architecture, building on existing arrangements but mindful of the requirements and constraints of the new legislation and the local system maturity. A key early step is to develop a set of agree Design Criteria which captures all these sometimes conflicting requirements. There will probably need to be a nested set of Design Criteria, as shown below.

Any design process needs to consider not only the why (captured in design criteria) but also the ‘what’ (the work to be done) and the ‘how’. Clarifying and agreeing the ‘how’, the design process, across partners is both a key challenge and opportunity. Agreeing this for the future ICS will help to simplify governance, streamline decision-making and reduce unnecessary bureaucracy.

The design must intentionally support ICSs to deliver both the ongoing statutory requirements (including those previously held by CCGs) and the capability to be the key engine room or enabler of the wider integrated care system at both place and wider ICS level. In many systems collaboration of local providers have, and will continue to, provide the ‘scaffolding’ for local place level system working. It is important that duplication and confusion is not introduced – ensuring clarity of purpose and roles, streamlined but clear coordination mechanisms and critically an enabling collaborative ‘way of working around here’. So, in some cases current CCG / future ICS staff at Place level will be most effectively deployed in supporting provider-led local infrastructure.

It is not as yet completely clear what the work of the future ICSs will be. As the government has published Design Frameworks and System Oversight Frameworks it is becoming clearer what they will be held accountable for, but there is a danger that we carry forward the old market driven ways of thinking and doing which have developed over the last 30 years.

As well as the need to challenge ‘what’ the new systems do, there is also significant flexibility in how systems choose to deliver that.  For example, the core work processes required, which will include at least some of what CCGs did, can be delivered by:

• ICSs directly
• Place level collaborations across partners including local authorities, voluntary and community sector organisations and NHS providers.
• ICS level collaborations such as shared data analytics function.
• Pan ICS support organisations or by one ICS for others such as for specialised commissioning.
• Key partners such as local authorities or provider collaboratives, leading on key issues such as tackling health inequalities or developing joint workforce strategies.
• Mix of the above, with variations across different Places and at different stages of ICS maturity.

As in any design process, the development of future ICSs is a great opportunity to re-purpose existing resources and assets of local organisations to meet the redefined core purpose(s). The resources may come from existing CCGs, CSUs (commissioning support units), non-statutory ICS/STPs teams, or local partners. Overall, each ICS needs to collaboratively design itself to ensure clarity of resource focus on delivering key outcomes for places and populations in line with the Design Criteria. Inevitably this will involve actively calling out and managing tensions in the design process.

The design of the new ICSs as both systems and organisations is a key opportunity and a complex challenge, which we will continue to explore over the coming weeks.

More information on integrated care systems can be found from the Kings Fund at https://www.kingsfund.org.uk/publications/integrated-care-systems-explained