1.1 Background: Working relationships across the NHS and London local government have developed significantly over the last two years, particularly joint work in response to the pandemic. London Councils recognises that the NHS faces huge and shared challenges, from elective recovery to financial constraint, recovery from the pandemic, as well as a focus on wider population health issues. We believe there is much that local government can bring to the table help address these challenges. We see an opportunity in the new arrangements for genuine partnerships which build on the recognition that the wider determinants of health have such a huge impact on health and wellbeing outcomes.
1.2 We welcome the steps that our health partners are taking at the regional, Integrated Care System (ICS) and borough level to work with local authorities as partners to design integrated care arrangements that meet the needs of our residents. We also welcome the priority given in the Integration White Paper and the supporting policy documents to an equal partnership between the health service and local authorities to come together to transform the health and care system.
1.3 Place level partnerships are a key component of the Integrated Care System. We are committed to ensuring that these partnerships set out a clearly defined approach to identifying and agreeing populations health needs.
1.4 London Councils welcomes a flexible approach to ICS development to make sure the system is best suited to meeting the needs of its residents, however, the roles of local government and place must be clearly defined within each system in order to achieve their core stated objectives.
1.5 Our key priorities:
1.6 Strategic planning and commissioning: ICSs must engage with all partners, including local authorities to clearly define the levels where service planning and design take place. Some services will be best planned and co-ordinated at system level, while some should be designed and delivered at place level. Place should be empowered to identify and determine where, in consultation with ICSs. Place has the greatest understanding of the needs of its residents and holds a crucial role in determining how best to effectively meet these needs. It is therefore essential that leadership and managerial capacity is enabled to drive the development of Place.
2.2 To achieve this, the following steps should be actioned:
We expect that this approach will support a co-ordinated approach across system and place level, as well as with HWBs.
3.1 The role of place and local authorities: We welcome the recognition of place’s role in ICSs as set out in multiple publications. The Thriving Places guidance highlights that place should play a leading role, and notes that “the considerations of what is undertaken at system or place should be guided by the principle of subsidiarity, with decisions taken as close to local communities as possible, and at a larger scale where there are demonstrable benefits or where co-ordination across places adds value.” The Integration White Paper reinforces the importance of place partnerships as the engine for delivery and reform.
3.2 To enable effective place partnerships, greater clarity should be established through formalised partnership arrangements. Governance should also be clear on how political representation is provided at the ICS and place and level, as well as the relationship with the HWB.
3.3 Local authorities expect to be equal partners in the design process for how strategic commissioning will work across health and care, at both place and system level, working with all partners to set overall outcomes and financial plans across all parts of the ICS. To support this, we expect that HWB Strategies and Joint Strategic Needs Assessments will be used as key tools for system and place level planning.
4.1 Funding and contracting: Place partnerships should be empowered to make resourcing decisions to improve how services are delivered for local populations (where it has been agreed that those services are best led at place).
4.2 There are significant challenges around the differing financial regulations of councils, NHS trusts and ICS bodies. Partners must be transparent about how money is budgeted and spent across health, local government and voluntary and community sector partners. Systems must be able to show how investment is growing in community-based prevention and early intervention, improving outcomes and reducing long-term costs.
4.3 Partnerships should integrate the lessons learned during the pandemic about joint purchasing arrangements and collective work on care packages, identifying further opportunities to improve value for money and better meet residents’ needs. Partnerships must also consider how these lessons can be used to mitigate and address workforce challenges.
5.1 Co-production: ICPs can hold a key role in enabling partners to take a more joined up approach to co-production and community engagement.
5.2 Partners operating across systems have already been taking great steps forward in developing their approaches to co-production and engagement with residents, however this has often been disjointed and in isolation from other partners. Local authorities have significant experience in engaging resident in planning and delivery across a range of services, and this represents a key strength which they bring to ICSs. Each council maintains strong networks and approaches to community engagement which can be used to support systems to implement this effectively.
5.3 Throughout the pandemic, health and care partners have worked more closely to co-ordinate engagement with residents, most significantly in the delivery of the vaccination programme. ICSs must ensure these lessons are not lost and can be used to inform the approach that systems and place partnerships take in the co-production and planning of services with communities.
5.4 Integrated Care Partnerships and place partnerships must be supported as key forums for engaging and providing a more joined up approach to community-based roles (including community champions, social prescribing link workers and community nurses) to ensure that work is not duplicated and does not operate in isolation. They must do this without losing sight of the lessons learned throughout the pandemic.
5.5 To implement this, partnerships should agree on reporting mechanisms on any co-production activity, as well as adaptable resident engagement.
6.1 Targeted approach to improving health outcomes: Councils operate as anchors of place and can have a key role in bringing in wider resources around ICS priorities, such as housing, economic development and advice and benefits. The planning of partnership working across these services, as well as health and care, is complex and needs to be informed by local populations (with significant variations within boroughs) and will require the ability to flex resource locally.
6.2 The implementation of ICSs on a statutory footing and establishment of the ICPs provides an opportunity to shift investment to early intervention and prevention through:
6.3 Delivering this will require sufficient decision making in relation to functions and resource at place level. This is reliant on previously identified expectation that place partnerships must be given the flexibility to determine which services they are best suited to lead the design and delivery of.
October 2022
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