End-of-year reviews

Three weeks ago Senior consultant Mason Fitzgerald wrote about the first 100 days of ICSs, and the need to continually review governance arrangements.

Now is also the time for ICBs and their system partners to consider their first end-of-year review, linked to the production of their first annual report and accounts. Such reviews are par for the course in the NHS, but we suggest a change of approach is needed for integrated care systems.

We must constantly remind ourselves that ICSs exist to:

• improve outcomes in population health and healthcare
• tackle inequalities in outcomes, experience and access
• enhance productivity and value for money
• help the NHS support broader social and economic development.

ICBs and trusts are now required by law to consider the impact of their decisions on the health and wellbeing of people, including inequalities. We also know that external regulators, such as the CQC and NHSE, will increasingly judge ICBs on the performance of the system as a whole, and also consider the contributions individual organisations are making to system objectives.

As we know, a key challenge for ICS leaders is to balance the need to deal with urgent operational issues and pressures while developing the programmes, systems and relationships needed to deliver improved outcomes for their local communities.

It is positive to see leaders stepping up to this monumental challenge, and some of the innovative approaches and support that are now available. For example, the Institute of Healthcare Improvement (IHI) CORE20PLUS collaborative programme is a fantastic opportunity that demonstrates what can and should be done in every ICS.

Taking all of this into account, at GGI we believe that an ICS end of year review needs to consider:

• the extent to which the ICS has clear and detailed plans to improve health outcomes and address inequalities, with demonstrable evidence of early progress
• development of the culture and behaviours required for system working, again underpinned by clear plans and a measurement framework
• the views of a wide range of stakeholders and partners on the effectiveness of the ICS
• the effectiveness of the ICB’s governance arrangements, including the alignment of governance activity and time with the ICS purpose, and engagement of system partners in governance forums and processes such as system risk management
• the timeliness and clarity of decision-making arrangements, aligned to principles of subsidiarity and distributed leadership, ensuring that leaders across the system are empowered and able to bring about necessary changes for their local communities.

A key question, and a test of system maturity, will be the extent that partners come together to plan and conduct their reviews in a spirit of mutual support, constructive challenge and continuous improvement.