Looking at what resources there are locally to help people improve their health and care. Using people’s skills, listening to what they need and looking at what’s available to help them. Involving people in identifying what will help to improve their health and wellbeing.
The care and treatment a patient receives from start to finish for a particular illness or condition. This usually includes several parts of the health service and social care. For example, a care pathway can involve support from a GP, a specialist doctor, home care and a district nurse.
CCG stands for clinical commissioning group. These are made up of groups of GPs, who work together in their local area to commission the best services for their patients and the population they work in. CCGs are responsible for about 60 per cent of the NHS budget. However, they are being abolished from July 2022 and their functions will be delivered by the new integrated care boards.
Commissioning is the way an organisation (the commissioner) can look at what services are needed. For example, to treat the health needs are of the people in the local area, and then create a process to ask other organisations, such as hospitals and mental health trusts (providers) to deliver the services that the people need. From July 2022, the health commissioners in each area will be the integrated care board.
Community health services provide a wide range of care, from supporting patients to manage long-term conditions, to treating those who are seriously ill with complex conditions. Most community healthcare takes place in people’s homes. Teams of nurses and therapists coordinate care, working with professions including GPs and social care.
Whether a patient goes to a doctor, the hospital or has care within their home, it’s important that the same standard of care is experienced and all the organisations involved in that care know what is happening. A patient’s care experience should be positive.
The bill is currently going through parliament and lays out the ways that the health and care services need to change to work better in the future. If it is approved by parliament and then given Royal Assent it will become law, becoming the Health and Care Act (2022), and will create the constituent parts of integrated care systems – integrated care boards and integrated care partnerships – from July 2022. It was developed because there was a recognised need in the NHS that things need to change.
HWBs are a statutory forum where political, clinical, professional and community leaders from across the care and health system come together to improve the health and wellbeing of their local population and reduce health inequalities. They have been running since 2013 and will become part of the new integrated care systems, working at place level.
These are campaigns to help improve everyone’s health and reduce health inequalities. Health promotion aims to help people take control of their own health and make it better, examples include breastfeeding support, exercise programmes and nutrition help.
Traditionally, some health and care organisations have tended to work independently, but patients often have lots of different needs. Integrated care is a way of getting health and care organisations including hospitals, GPs, councils and voluntary organisations, to work together in a way that helps patients. It has been happening successfully in some areas for a long time but the health and care bill makes it official.
This is the system that brings together the health and care organisations in a particular local area, to work together more closely. There are 42 ICSs across England and they will be formally established as legal entities in July 2022, subject to legislation being agreed by parliament, although they operate as voluntary partnerships of local organisations in the meantime. Many health and care organisations have already been working in this integrated way successfully, particularly through the pandemic, and statutory footing represents the next step in recognising this success. Each integrated care system will be responsible for planning health and care services in the area it covers. Each one will be made up of an integrated care board and an integrated care partnership, which will work in tandem to meet the needs of their population.
The integrated care board holds responsibility for planning NHS services, including those previously planned by clinical commissioning groups (CCGs). As well as a chairs and chief executives, membership of the board includes ‘partner’ members drawn from local authorities, NHS trusts/foundation trusts and primary care. The ICB should ensure that services are in place to deliver the integrated care strategy developed by the integrated care partnership. ICBs will be created as statutory organisations, including a governing board, from July 2022.
The integrated care partnership operates as a statutory committee. It is made up of partners from across the local area, including voluntary, community and social enterprise (VCSE) organisations and independent healthcare providers, as well as representatives from the ICS board. One of the key roles of the partnership is to assess the health, public health and social care needs of the area it serves, and to produce a strategy to address them. This, in turn, will direct the integrated care board’s planning of health services and local authorities’ planning of social care services. ICPs will be created from July 2022, supported by a secretariat but not employing staff as an organisation.
Health and care services working together to better support a patient, making sure that everyone involved in a patient’s care, from their GP to their nurse, from the hospital to their care worker, knows and understands the patient’s needs and what care they are receiving.
Within an integrated care system, there are a number of levels. Neighbourhood is the smallest area at which services will be delivered to patients. A neighbourhood will look after around 30 to 50,000 people and will be made up of GPs, pharmacists, dentists and opticians all delivering primary care services together as a primary care network. A neighbourhood often corresponds with an electoral ward of a district or borough council.
This is a plan for the future of the NHS, written using feedback from staff and patients. It includes many of the changes which have been included in the health and care bill. You can read more details about the plan on the NHS England and NHS Improvement website.
This is the next level within the new integrated care systems and sits above neighbourhood. A place will usually include around 250 to 500,000 people (although this will vary) and will be made up of place-based partnerships between the council-run health and wellbeing boards and all the health and care organisations that sit within that place area, such as the hospitals, care providers and voluntary groups and. Each place will look at the health needs of the population it covers, and make sure those needs are met locally.
Population health means looking at all the information about a particular population to see what things are affecting health. For example, poverty, poor housing, obesity levels, and access to health services. There are many things that can lead to poor health, which is why it’s important for councils and health services to work together. Integrated care systems will be tasked with improving the population health of the area they serve.
Prevention involves working to improve people’s lifestyles to try to prevent ill health from happening in the future. For example, stop-smoking campaigns to prevent cancer cases, or weight management programmes to prevent obesity-related problems.
This is the first level of care people access before going to a hospital. It includes GPs, dentists, opticians, pharmacists, community health teams and mental health community teams, as well as social care. Hospital care is considered to be secondary care.
PCNs are groups of GP practices that work with each other and with community, mental health, social care, pharmacy, hospital and voluntary services in their local areas. They are led by a clinical director who may be a GP, general practice nurse, clinical pharmacist or other clinical profession working in general practice.
Provider collaboratives are provider organisations working together as part of the new integrated care system, to make sure they are delivering care in the best way possible for the people who live in their area. Providers often deliver similar services, so it makes sense for them to work together to ensure they aren’t both doing the same thing. For example, they could work together to provide a joint cancer service. This can make it easier for patients and can save money. Provider collaboratives can vary in the depth of integration, from a loose collaboration of healthcare providers who meet regularly to plan services in a joined-up way, to a more formal integration of legal governance.
Public health is usually run by a local council, and includes running health programmes that help to improve the health of everyone living in the local area, such as encouraging exercise, healthy eating and weight management. It includes work on wider issues affecting public health, such as poor housing or poverty.
These are responsibilities that have been laid down in law, and must be carried out by a health or care organisation. For example, from July 2022 all ICSs will have a statutory responsibility to deliver health and care services in their area.
System working is the description used for how integrated care systems will be working from July 2022. It’s about health and care services working together in a particular area, to make things work better for patients.
This refers to organisations that are not profit-making businesses and are not public bodies such as councils, or the NHS, so it generally means charities and voluntary organisations. Anything that is not private sector, or public sector is considered third sector.