Place-based partnership review

Introduction

NHS Lancashire and South Cumbria Integrated Care Board (ICB) carried out a review exploring the option of aligning the place partnerships to the four local authority boundaries to promote and enable deeper integration and collaboration with health and social care in order to improve population health, hospital flow and discharges into the community.

On Wednesday 27 July 2022, the board of NHS Lancashire and South Cumbria made a decision based on a paper setting out recommendations following the review. The paper can be found online in the ICB board papers.

The role of place-based partnerships is integral to the future of the Lancashire and South Cumbria system achieving a collaborative approach to health inequalities and the wider determinants of health for our communities throughout the life course.

The review

The place review involved over 170 conversations with groups and individuals including existing place-based partnerships, primary and community care, provider trusts, local authorities, public health, adult social care, voluntary, community, faith and social enterprise partners, and was supported by an online survey which was responded to by 243 NHS staff and place partner staff.

The comprehensive review revealed noteworthy levels of support for the realignment of boundaries but also revealed partner and stakeholder questions about the development of the ICB, its operating model and the remit of place-based partnerships. Contributors raised concerns around the places’ ability to commit resource and delegation of funding, clinical leadership, the dialogue between primary and secondary care and the operating geographies of valued groups – including GP alliances and GP leadership groups. The discussion, and subsequent decision, was made with full consideration of these findings from the review.

The Board had previously approved the next steps to develop an ICB plan to develop integrated neighbourhoods, as part of an item on the Fuller Stocktake Report which addressed some of these issues.

The decision

The ICB board decision covered the following elements in relation to the boundaries of place-based partnerships:

  • Realigning the current place based boundaries to the two upper tier and two unitary Local Authorities within the footprint: Blackpool, Cumbria, Lancashire and Blackburn with Darwen

  • Mirroring adult social care arrangements within Lancashire, meaning there will be three delivery units including: East Lancashire, Central Lancashire (include West) and North/Coast, to enable deeper integration.
  • Mapping places and delivery units to district footprints to support collaboration on wider determinants of health.

Importantly the board also discussed and agreed to focus on implementation:

  • Aligning to plans for an Integrated Care Board target operating model, which impacts on all aspects of remit, scope, and governance at system and at place.
  • Agreeing a timeline for the establishment and development of place over the next three to five years, with a clear statement of remit, delegations, and desired outcomes.
  • Developing clear OD plans that support teams to move to a new way of working
  • Producing a Clinical and Care Professional Leadership Framework (ready to implement from 1 January 2023)
  • Working with primary care colleagues to develop a primary care network
  • Developing a delivery model to take account of new responsibilities for the four pillars of primary care and progress quality assurance and improvement oversight
  • Considering future governance arrangements
  • Recognising critical partners, such as hospices and VCSFE partners.

The board invited contributions to the discussion from a number of representatives from Local Authorities, VCFSE and general practice. The Board recognised concerns that were raised and made specific recommendations that these are addressed, and closely reviewed, in the development of place-based partnerships in Lancashire and South Cumbria.

Further context

National policy and the new legislation set out in The Health and Care Act 2022 sets out a clear intention of a more joined-up approach to health and care built on collaborative relationships; using the collective resources of the local system, NHS, local authorities, the voluntary sector, and others to improve the health of local areas.

During 2022/23, NHS England has been clear that there can be no delegations to place-based partnerships from the ICB. The ICB executive has determined that while places will not have a commissioning function, they will be the engine room and focus of the integration and health creation ambition. Progressing integration and tackling health inequalities in the places citizens live will, as a principle of the target operating model, be prioritised for investment funding. The Board has agreed to the establishment and development of place with a clear statement of remit, future delegations, and desired outcomes. This will help all partners understand what is within and outside of the scope of place based partnerships. Understanding the framework within which place operates will help partners at place build or maintain trust relationships and develop a common purpose. Together the place framework and the ICB target operating model will help all colleagues and partners understand where decisions and dialogue will take place.

The board members recognise the excellent work that has taken place to develop place-based partnerships in Lancashire and South Cumbria, and during the board meeting offered thanks to staff and partners for their significant progress made in forging relationships within their places and working collectively to serve the local communities.

More information

The Frequently Asked Questions include additional information and common queries staff and partners may have.

 

 

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