The role of the proposed NHS Assembly in establishing the status and reality of an Integrated Care System.

Something that is true of any large organisation or service sector, is that important changes quickly become acronyms and, by the magic of becoming an acronym, the letters quickly lose the meaning of the words.

In recent years the most striking example of this for me was the BCF. Within minutes of being created the Better Care Fund became the BCF. Those initials didn’t lose any meaning at all – because for many organisations BCF equalled getting some money. But they quickly lost the connotation of better care.

One of my more infuriating habits I use when working with people is to get them to explain what acronyms stand for. This can cause sometimes cause anger – or at least irritation – but it provides an important opportunity to raise some basic issues about what we are doing.

“What does BCF mean?”

“It means Better Care Fund.”

“Ah – so how has anything we have been talking about for the past hour been about better care?”

The same is true for ICSs. It’s a lot easier to bureaucratise an acronym – “I’m just off to the ICS meeting.”  But it’s different if you are “just off to create integrated care”. If you are meant to be in a meeting about integrated care and after the first hour have not talked about care at all, it seems worthwhile to raise this as a problem. On the other hand a meeting about ICSs is about exactly what?

After yesterday’s post about a confused policy in which I suggested that while you might have ICSs everywhere by 2021, that doesn’t mean to say you will get integrated care everywhere because they are not all going to make it within 2 years – some people have said, “OK so how might we do it differently?”

Unlike the process of becoming an FT, there is no independent organisation (called Monitor) which can judge whether localities are up to becoming one.

Now of course legally there is a Monitor – but that was rolled in with the Trust Development Agency which was then rolled into NHS Improvement, which was bundled with NHS England who have written the policy and are therefore not independent.

But there is in the Long-term Plan a pledge to create a NHS Assembly (soon to be called NHSA?) by early 2019. This is separate from the boards of NHSE/I and will “advise them”[1]. So why not advise them on whether a local area has the ability to develop, within its system, the reality of integrated care?

They could work with the local health watch to look at the capability of local systems to develop integrated care. They could talk with patients in that locality and ask them if they experienced coordinated person-centred care. They could discuss with the public what proportion of care is still in silos and what was integrated. They could work with National Voices and the Richmond Group to mobilise and test local patient opinion.

In short they could make a judgement about whether the proposed ICS actually delivered care that was integrated.

Giving the power to say whether a local system is an ICS to patients who are concerned about integrated care obviously ONLY makes sense if that is what ICSs are for.

If ICSs are actually aimed at creating regional health authorities with a different acronym then it would be much better to have a judgement made about their capacity to act as a regional health authority by a national body such as NHSE/I.

It all comes down to this question. Is it the job of ICSs to deliver integrated care in their locality?

If the answer is ‘yes’ then asking patients if they are doing it would seem like a way forward.

[1] Long Term Plan par 7.17