Thread by @ChrisCEOHopson

1/17 Important new @NHSEngland consultation paper on speeding up integration of health and care and system working at local level issued yesterday: england.nhs.uk/wp-content/upl…. Some initial thoughts in my new tweet thread below. @NHSProviders briefing here: nhsproviders.org/media/690574/2…

2/17 Document sets out detailed proposals for how health & care integration should work on ground going forward, from April 2021. And legislative options for NHS Bill next year on how to put ICSs on statutory basis (from April 2022?) Therefore triggers a very important debate.

3/17 Universal support for the need to speed up integration of health and care at local level, so strong agreement on the strategic direction of travel. Important to remember this as there will be different views, some of them strongly held, on the details of how to do this.

4/17 Every trust leader I know wants to work much more closely, at pace, with primary care, social care, local authority & 3rd sector partners on their patch. And the same with neighbouring trusts in their wider system. COVID-19 completely reinforced value & importance of this.

5/17 Given that 80% of care is delivered on a trust's immediate patch, trust leaders will therefore welcome the strong focus in the new proposals on "place". As places like Wigan and St Helens have shown, integrating health and care at neighbourhood and place levels is vital...

6/17 ...This isn't just about system working on an ICS/STP footprint - Cheshire & Merseyside / Greater Manchester - important though that is. Previous policy on system working failed to fully acknowledge this, so it's very positive that this has now been corrected.

7/17 Trust leaders will also strongly welcome the focus on providers working together in collaboratives. COVID-19 is clearly showing that the NHS provides the best care and outcomes when providers work together. We need a broad definition of what provider collaboratives mean...

8/17 ...COVID-19 has shown power of NHS trusts working together in an ICS/STP to share PPE & supplies, recover waiting lists, exchange & train staff & temporarily reconfigure services to make best use of resources. Maximising benefit of working in a National Health Service...

9/17 ...But COVID-19 has also shown the power of acute hospital, community services, mental health, ambulances, GPs surgeries / primary care and social care seamlessly working together at place level, below the ICS/STP level. Both forms of provider collaborative are important.

10/17 Trusts will also strongly welcome move to strategic commissioning at a system level. This will eliminate the waste and duplication we've seen too often when clinical commissioning has turned into excessively detailed, tactical, unnecessary, low level, contract management.

11/17 So, strong support for strategic principles of 1. Speed up health & care integration. 2. Strong focus on place as well as ICS/STP system level. 3. Enable more and better collaborative working between providers. 4. Strategic commissioning at the system level.

12/17 Key, as ever, is detail of how to make this work in practice. The new document shows that getting the accountability, governance, financial flows, oversight, regulation and statutory underpinning of all this - the "plumbing and wiring" - will be complex and difficult....

13/17 ...There's a huge amount of risk, financial and human resource and complexity to manage in health and care. And, ultimately, patients' lives are at stake. So good and clear governance, accountability, assurance, risk management and oversight couldn't be more vital.

14/17 The proposed approach requires the right balance / relationships between providers, provider collaboratives, neighbourhoods (including Primary Care Networks), places, systems, @NHSEngland regions, @NHSEngland nationally, local authorities and the 3rd sector.....

15/17 ...That's a lot of players on a pitch! We must be clear about who does what, who is accountable for what, and how the money flows. We must ensure that the strategic intent and the law fully align, unlike the current position. We must avoid duplication and overlap.

16/17 We must ensure that each statutory body has the right, effective & transparent governance with appropriate public involvement and accountability and non-executive input. We must also remember THE strategic intent is to integrate health & care, not top down reorganise NHS.

17/17 There's a huge amount to do to get this detail right. It's vital this is done in full collaboration with frontline leaders who will have to make it work on the ground. We welcome the engagement the document starts, but this needs to be genuine, full, co-design!

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