Ministers must not lose sight of “crucially important” prevention agenda, say MPs

MPs are concerned that acute short-term NHS pressures could be given priority over longer term ambitions such as preventing ill-health, according to a new report.

The report, Integrated Care Systems: autonomy and accountability, is based on the Health and Social Care Select Committee’s recent inquiry into how Integrated Care Systems (ICSs) will deliver joined up health and care services to meet the needs of local populations.

The Committee found that while there is a lot of optimism about the 42 new ICSs, there are also are concerns that their potential will not be realised, and that, in a number of areas, there is a serious lack of clarity.

Chair of the Health and Social Care Committee Steve Brine MP said: “We have found genuine enthusiasm for the potential of Integrated Care Systems to make a real change, not only in how health and social care is delivered but in prioritising the needs of local populations and preventing ill-health.

“It would be an opportunity lost if that success was undermined by the need to prioritise central government targets or a focus on meeting short-term demands. We urge Ministers not to lose sight of the crucially important prevention agenda and we call for them to adopt a light-touch outcome driven approach to this new way of working.”

What did the report find?

Autonomy and accountability

By focusing on autonomy and accountability, the Committee explored how the government intends to protect the flexibility of ICSs and how they will be held to account for partnership working.

MPs say it accountability measures are currently unclear, and they recommend that the Department of Health and Social Care (DHSC) works with NHS England to provide more clarity about this.

The report also highlights that NHS England’s “command and control” approach must change to allow for more flexibility. While it is right that the government and NHS England sets outcomes for ICSs to work towards, MPs say it is vital they do not dictate how ICSs should deliver the outcomes.

“We recommend that any targets are outcomes-based and that any greater prescription is done sparingly,” they write.

Addressing population health and health inequalities

When the 42 ICSs were established in July last year, a key focus was to deliver joined up health and care services to improve population health and tackle health inequalities.

The Committee notes that with the current intense short-term, operational challenges facing the health and social care system, there is a risk that this will dominate ICS capacity and resources.

To tackle this, the report states that the DHSC and NHS England must make active efforts to focus on longer-term work such as public health and prevention.

MPs suggest the government publishes an updated version of the NHS Long Term Plan, which puts prevention and long-term transformation at its heart. They also suggest that all Integrated Health Boards include a public health professional or public health director.

ICSs should not become too NHS centric

Other key suggestions in the report include:

• Partnership working needs to be about more than just collaboration if there is to be true integration within ICSs
• Social care must not be forgotten, and ICSs should not become too NHS centric
• Government must recognise that accountability in the NHS is different to that in local authorities, and an effort made to ensure they work well together.

In their concluding remarks, MPs say it would be “disappointing if the opportunities for real change were missed” and they urge the government and the NHS to promptly address the issues they have identified in the report.

Government must ensure that ICSs have the capacity to focus on public health and disease prevention

Sarah Walter director of the NHS Confederation’s ICS Network says ICS leaders “will be pleased to see the report reflect the key challenges they face”.

“In particular, ICS leaders will be pleased to see the recommendation from the committee that targets for ICS should be outcomes-based, as this will be one of the key drivers or brakes on the ability of ICS to truly transform the delivery of health and social care.

“Although there is an understandable need to deliver improvements against some of the immediate priorities facing ICS, we would agree with the committee’s position that long-term improvements to care and health outcomes for communities will be dependent on ICS having the capacity to focus on public health, prevention and their role in the local economy.

ICS leaders now await the publication of the Hewitt Review, which will consider how these recommendations can be implemented.