To be successful ICS must learn to listen

    

There is much trepidation and promise in the air for the new Health and Social Care white paper. One of the big promises is that the Integrated Care Systems (ICS) will help to sort out many issues for the health and social care systems, including better cooperation and joint working. Previously we have had many pieces of legislation that have asked for integration, albeit with little promise or improvements. Hopefully we now have an organisation who will and has the power to make it happen. 

 

I am a firm believer in learning from our mistakes, looking back and contemplating how things could have been done differently to lead to a better outcome. I have written several posts about the need for effective dealing of complaints and in turn using the data to improve services. Something that still has not been fully implemented. If the ICS move forward they must remind themselves of what went behind them and why the changes have been implemented.

 

With the new ICS, I can still see two major issues or hurdles that might concern me. The first is structure and independence. Some of the issues I have seen in the past have been due to the structure of CCGs. 

 

When you look closely the CCG are a collaboration of individual businesses (Doctors/General Practitioners) who come together and make decisions on what happens locally via the Clinical Commissioning Group (CCG). In essence a group of private companies running a government service. Obviously there is a concern here of a conflict of interest. For example; it could be suggested that their influence over funds might be swayed for their own benefit. I am not saying it is the case, but it does make me ponder. GPs get paid based on population so the more local people they have on their patch the more they get paid, alongside a points based system on certain types of treatments. A local authority who builds and builds in a particular area (everywhere at the moment) means that the GP gets more patients, meaning more money. However, where is the extra money and investments going? Not back into the surgeries that I can see?

 

Most people think that the NHS is one whole system that works unilaterally as a whole. Unfortunately this is not the case. My work with the central NHS shows that there is a lot of promise and innovation at the top end. Particularly  in relation to Personalisation and Peer Leadership, which is primarily about working with people   who use the services people with lived experience. If you want to know more about peer leadership and how it can help improve involvement  contact  england.PLDP@nhs.net .

However, the CCGs locally seem to as legal entites themselves pay little heed to guidance that comes from central NHS and seems to implement its own rules almost on an ad hoc basis. The Government or NHS central seem from my perspective seem to have difficulties managing this as you would expect.

 

Over the last two years, I have looked at our CCG in detail and the majority of the issues point to the above factors. A few years ago the government asked the CCG to make cuts via improvements and not to services, yet the CCG decimated services.

 

Another major issue is that the conglomerate of local GPs tend to run the actual CCGs in the same structure, ie. GPs and care professionals making all of the decisions. An example of this is the patient participation board in our CCG. How many patients or people with lived experience are there? I will leave that to you to mull over. The patient involvement is virtually non existent. I have examined three separate processes all of which require by law proper consultations under the Equality Act 2010. Having examined the paperwork, including Equality Impact Assessments (EIAs), they would really struggle in my view to prove that they had involved people and paid proper due regard to the issues in hand. They are really good at sending out badly worded surveys, but where are the results? 

 

I jumped at the chance to be a Community Champion for the CCG, my inbox is full regularly of please share this, but how many meetings have we had where we have been given a chance to feed back in six months, again i would suggest looking at good practise from personlised care at central NHS. The work with Peer Leaders is structured, involves training people on the make up of the NHS and how it works, but more importantly provides an avenue for people with lived experaince to be utalalised to there full potential for the benefit of the NHS

 

The Local Authorities do not get away with it easily either. Their involvement is very ad hoc, patchy and very tick box paper based. I have had to remind the authority on two papers going to committee recently, one on how they can send papers for approval for commissioning of a service, when the paper consultation is not over? And the second paper the only original idea in it is one from a blog I had written three months ago. They instead rely on what the government campaign says to justify what they're doing in relation to the problems. Again here  by utilising the people at the front end who know what is required, they could reap many benefits. 

 

If we are to sort out the problems in health and social care, the new ICS's must have robust involvement from the beginning. They must learn to listen and take feedback on board. Without it we will have changed nothing but in name. These services belong to the people. It is they who pay for them. They must quite rightly not only have a say, but must be sat at the table making decisions. From experience, the people who use the services often have cheap innovative ideas that can be implemented to help services improve. In most cases, all that is required is an open and honest conversation.

 

It was good to hear that the health minister mentioned the importance of Personalisation in his recent speech. He gave an example from his personal life, his mother made her father stop smoking by reminding him that it was his responsibility to make things better. It's a good point. We have a responsibility to be involved. But that can only happen if you are willing to not only listen but hear and implement the things that are asked of you. 

 

#personlisation, #CCG, #ICS, #Localauthortises, #LA, #involvement, #coproduction, #openconverations, #duties, #EIAs, #EqualityAct, #particpation