Since Labour took power we’ve been waiting with baited breath for the health team to start delivering on their promise to build an NHS Fit for the Future.
On Wednesday Streeting strode on stage at NHS Providers to in his words “give the NHS its marching orders”. Trailed in the press in the days leading up, we eagerly tuned in to get our first real glipse at Wes Streeting’s vision for future.
Wes came out fighting, setting out a no-nonsense stall and clearly unafraid to ruffle feathers. While some have questioned his approach, it is refreshing to see decisive action being taken.
The headline announcement from the speech is that the government is moving the performance management of providers away from Integrated Care Boards (ICBs) and back to the centre. Those that are performing well will be given freedom to innovate and continue to improve. Those that are not doing well will be held to account by the government with a clear emphasis on shape up or ship out.
Clarifying these responsibilities was a recommendation from the Darzi report, and should provide transparency around accountability. What Wes has done is create a fundamental shift and this could be just the tip of the iceberg for the future of ICS’.
There have been rumblings about the reduced role for ICS for some time. The previous government sought to reduce and refocus the energies of ICSs through the Hewitt Review and there was a sense that they were viewed as cumbersome and unfocused. And then the cost reduction programme left many ICSs with skeleton teams which forced them to proactively refine their roles in local areas. At the same time provider collaboratives were – on the whole – thriving taking a proactive role in commissioning and designing services.
What does this mean for organisations wanting to work with the NHS?
These changes bring into question who the customer is for organisations wanting to partner with the NHS and suggests that ICSs are now essentially redundant.
Without funding or authority, they amount to little more than a forum for discussion, and with commissioning powers significantly restricted by the tight grip of the centre, the ability of ICS to support innovation is limited at best.
With this line of thinking, Trusts and Provider Collaboratives become the centre of the universe once again, with ICBs pushed to focus on ‘strategic commisisoning’, transformation and planning at a local level but with little formal power.
This underlines the need for NHS partners to have deep market insight so they can understand priorities particularly against the backdrop of the coming 6 months leading into the 10 year plan. This includes detailed insight of how systems are changing and who the key commissioning decision makers are. With 200+ Trusts and Providers in England, keeping track of the movers and shakers might be difficult, but it is vital.
Is this the end of ICS’?
A more optimistic viewpoint is that this shift in accountability should actually free up ICBs to deliver their mandate and focus on integration and building innovative collaboration at a local level as recently announced by north west London ICS and their integrated neighbourhood teams.
With the government and NHS England wielding carrot and stick over providers, ICBs can work with other partners in the ecosystem, and focus their energies on empowering primary care to deliver the prevention agenda, supporting social care services, and building the structures and process which enable the different parts of the system to work together.
The government clearly believes it needs to take the bull by the horns and drag the NHS to improvement. Whether you believe Streeting has shackled ICS’ or set them free, it is clear that their role has fundamentally changed.
It will be interesting to see how this shift continues in the coming months as we build towards the launch of the 10-Year-Plan in May. With winter around the corner and performance data once more going in the wrong direction, the pressure is on.
Comments