Integrated care systems: A solution to capacity constraints
This weeks industry-led long-read sees Claire Reader, chief operating officer for Community Care at Newcross Healthcare, explain why integrated care systems are vital in helping to ease NHS pressures, but questions whether the model could benefit from some improvements.
For years, the National Health Service (NHS) has grappled with a critical issue: capacity constraints caused by ‘bed-blockers.’ These are patients who are medically fit to leave the hospital but occupy beds, preventing new patients from accessing necessary care.
There has been a call for more ‘integration’ across health and social care for many years, if not decades, to end a silo approach that is not only inefficient but can see the NHS taking workers away from social care at a time when it scarcely can afford to be without them.
After some years of preliminary steps on such integration, a landmark in healthcare history saw the Health and Care ACT 2022 place Integrated Care Systems (ICS’s) on a statutory footing for the first time.
Under this legislation ICS’s (via Integrated Care Boards (ICBs) and Integrated Care Partnerships (ICPs)) are charged with fostering true collaboration across social care, the voluntary sector, and the NHS.
Working through their ICB and ICP, ICSs have four key aims:
- Improving outcomes in population health and health care
- Tackling inequalities in outcomes, experience, and access
- Enhancing productivity and value for money
- Helping the NHS to support broader social and economic development.
In January 2023, NHSE estimated that over 14,000 patients were occupying beds, when they were in fact well enough to be discharged to the community with the right care plans in place. For the same period, figures also show that more than 19 in 20 beds were occupied across adult general and acute hospital wards.
In recognition of the capacity constraints, the government announced upwards of £250m to free up hospital beds, but in the words of respected title, HSJ ‘[this investment] has so far failed to deliver any significant reduction in delayed discharges – with multiple systems instead reporting large increases.’
In a recent Voices of Care Podcast, the former Chief Executive of the NHS, Sir David Nicholson hailed this new landscape as a profound shift from a ‘competition’ lead model within the NHS to one of collaboration. It is a view we whole heartedly agree with and believe that the implementation of ICBs holds immense promise in tackling this challenge.
One crucial factor exacerbating capacity constraints is the ongoing shortage of social care workers. In a recent 2023 report from Skills for Care it was stated that the social care sector had over 152,000 vacancies; whilst down from 165,000 in the previous year, the shortfall is having an impact at a number of levels: the wellness of the workforce, efficiency and, ultimately, impact on quality of care.
This shortage also directly impacts secondary care, preventing hospitals from swiftly discharging patients who no longer require hospital-level services and straining resources further.
To address these issues, there must be a shift towards embracing an integrated healthcare model. Successive governments have been postponing the implementation of this model, but in an election year, it is essential for political parties to confront this challenge head-on. By adopting a comprehensive approach that considers the entire care pathway, governments can create a more efficient and sustainable healthcare system.
ICBs offer a solution by connecting health and social care services, bridging the gap that currently exists between primary, secondary, and social care. The goal is to empower healthcare providers to work collaboratively and sequentially to ensure patients receive the appropriate care in the most suitable setting. This model facilitates the seamless transition of patients from hospitals to community-based care, alleviating the pressure on acute services and freeing up beds for those in need.
However, the successful implementation of ICBs relies on essential funding mechanisms that follow patients across their entire care journey. A key issue in the current system is that funding is often allocated based on specific sectors rather than taking a holistic view. Consequently, when patients transition between settings, the funding does not necessarily travel with them, resulting in fragmented care, delays, and barriers to timely discharge.
To unlock the full potential of ICBs, it is imperative that funding systems are reformed to ensure a person-centered approach. Adopting a whole-system funding model that allows resources to move with the patient would enable healthcare providers to meet individuals’ needs flexibly and efficiently. It would also encourage investment in community-based and social care services, ultimately reducing the strain on hospitals and enabling patients to receive appropriate care in the most suitable environment.
Moreover, the successful integration of health and social care requires a comprehensive workforce strategy. Addressing the social care workforce shortage is pivotal to alleviating the burden on secondary care, reducing bed-blocking, and facilitating timely discharges. Investing in recruitment, retention, and training initiatives for social care workers would create more opportunities for patients to receive care outside of the hospital setting and within their communities.
The promise of ICBs extends beyond relieving capacity constraints. By implementing an integrated healthcare model, we have the opportunity to enhance patient outcomes and experiences. A more coordinated and person-centred approach ensures that patients receive seamless care tailored to their needs, preventing unnecessary hospitalisations, and enabling early intervention in community settings.
The implementation of ICBs presents a tangible solution to the capacity constraints faced by the NHS. By connecting health and social care services and reforming funding mechanisms to follow patients across their care pathway, we can address bed-blocking and unlock the potential of an integrated healthcare model. There is a long way to go and former Health Secretary Patricia Hewitt conducted a review of the ICS landscape in 2023 and recommended many reforms including affording them even more autonomy to drive better outcomes for local populations.
As the election year approaches, it is crucial for political parties to acknowledge the urgency of this issue and commit to embarking on this transformational journey. The promise of ICBs cannot come soon enough – it is an opportunity to revolutionize the healthcare system and improve patient care.
Images: Shutterstock, Claire Reader and Ani Kolleshi
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