Thursday, October 18, 2018 - 11:30
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Interview with Professor Des Breen on integrated care systems (session E3 preview)

Professor Des Breen, Medical Director, South Yorkshire and Bassetlaw Integrated Care System, provides a preview of an important session he will be presenting at the Leaders in Healthcare conference next month, From neighbourhoods to systems – what does integrated care look like?

The session will focus on NHS England’s expectations for the emerging landscape of health and care provision in England, what integrated care systems (ICS) and sustainable transformation partnerships (STPs) should look like, and will be delivered by Prof Breen with Claire Fuller, Senior Responsible Officer for System Transformation Partnership, Surrey Heartlands and Ian Parry, Development Manager at Staffordshire County Council, on Friday 16 November, 1pm – 2pm.

The shape and progress of integrated care has taken on a new lease of life since NHS England chief executive, Simon Stevens, started to talk about the new 10-year plan for the NHS in England this summer and offered a glimpse of the forthcoming approach to service change – which concentrates on collaboration, not competition.

South Yorkshire and Bassetlaw is one of only four integrated care systems in England which has reached ‘level 2’ maturity: it is still early days for ICSs and no one has reached ‘level 3’ yet.

Prof Breen explains: “Integrated care systems have grown out of STPs, with South Yorkshire and Bassetlaw being relatively large. Our ICS is made up of 35 neighbourhoods of between 20,000 – 50,000 population size. Strengthening primary care and networking of practices is the main focus for us at this level. These neighbourhoods are clustered into five places with a population of 250,000 – 500,000. It is here that primary, secondary, community care and social care can integrate better to serve the local population. We believe that most of the changes will happen at neighbourhood and place level. The ‘system’ level of the ICS is made up of the five places and in total serves a population of 1.5m. This provides system leadership across five local authorities, five clinical commission groups, six acute hospital and community trusts, four care/mental health trusts and 208 GP practices that cannot be done at neighbourhood and place alone. There is also a strong focus on public health and keeping people well.”

It has been acknowledged that ICSs like South Yorkshire and Bassetlaw are breaking new ground when it comes to developing effective system leadership, working hard to ensure all parts of the health and social care system are integrated, moving on the same journey and towards the same goals.

Prof Breen continues: “The leadership challenge for all integrated care systems is centred on the system’s maturity, the quality of collaboration and relationships, as well as the level of trust and the depth of shared vision.  In the absence of a legal framework, each bit of the system has to find a way of working together effectively. All of which takes time as this kind of distributive leadership has not been done before.

“Relationships between the senior executive leadership within South Yorkshire and Bassetlaw are strong because we have a long history of working together. But in any ICS, it is particularly important to get the clinical leadership from all professions and specialties within place, systems and organisations, and across care pathways, for it to work.”

Workforce is considered one of the biggest challenges, as we look at developing roles where they have not existed before, including greater deployment of a non-medical workforce, such as pharmacists, advanced nurses, physicians associates and allied health professionals, as well as links with arms-length-bodies.

Prof Breen agrees that being a medical leader and advocating for non-medical leadership can be positively impactful.

“We are working together collaboratively and navigating a health and social care system where the fundamental architecture has not changed since the NHS was established in 1948. This is the first attempt to address the needs of all parts of the system from within and therefore the leadership must also come from within the system.

“This is the biggest change and very different to running a specific department with a clear budget. With an ICS there is no rule book and it will take a different kind of leadership.”

The session at this year’s Leaders in Healthcare will talk through the architecture and examples of what the ICS can do at ‘neighbourhood’ and ‘system’ level, as well as what it can do at ‘place’ level. It will look at the challenges of system leadership as well as the importance of clinical engagement across the workforce.

Prof Breen concludes: “Many doctors and clinicians have yet to fully understand the purpose and workings of an ICS and their roles in it. Part of my session at the conference session will focus on the understanding that the strength and success of an ICS is dependent on the quality of engagement with primary care.”

Professor Des Breen is a long-serving member of FMLM. His session, From neighbourhoods to systems – what does integrated care look like?  takes place on Friday 16 November, 1pm – 2pm, at Leaders in Healthcare 2018 in Birmingham.