New ways of working: ICSs in action

Since the formation of integrated care systems, there has been plenty of talk around how new ways of working and new care pathways can be implemented to help manage increased demand. Here, we take a look at some practical examples from across the ICSs.

A new approach to frailty pathways in South Tyneside

North East and North Cumbria ICB is testing a new scheme for patients who are frail or who have complex health conditions in South Tyneside. Identifying those at risk of hospital admission, the scheme invites these patients to meet with doctors, social prescribers, physios and other specialists, at an all-in-one “Living Well” appointment.

The specialist team develops personalised plans for patients, to help them “stay healthy and independent at home for as long as possible”. One of the clinic’s aims is to help support patients in managing their own conditions more effectively, providing proactive care which “reduces the risk of long-term health conditions worsening and leading to a hospital stay”.

Edd Nowicki, a geriatrician at South Tyneside and Sunderland NHS Foundation Trust, said: “We hope that the clinic will improve patients’ clinical, social, financial, and spiritual care, helping them to stay well and in society without the need for emergency hospital admissions. It’s a chance to take control and to make sure that the health and social care system helps them through every day.”

New hub brings together NHS services under one roof in Solihull

A new hub has been launched in Solihull, which brings together a range of NHS services and healthcare professionals from general practice, community services and acute care, under one roof.

Professionals including respiratory nurses and therapists, community nurses, advanced clinical practitioners, and allied health professionals, will provide same day, early intervention and crisis response care, as well as supporting preventative treatment for patients with chronic or long-term illnesses, who are at risk of deterioration.

Dr Tara Shah, clinical lead for Solihull and GP at Bosworth Medical Group, said: “After existing hubs in Birmingham were evaluated, we felt that adopting this joined-up approach in Solihull would clearly benefit our patients. By having a team with diverse clinical experience providing these services, it is hoped that patients will be seen more quickly and by the right healthcare professional at the right time. We hope that the hub will allow us to care for more patients in the community, meaning fewer people need to go to A&E and speeding up access to secondary care advice and guidance.”

Community health screening in Northamptonshire

A new community health screening programme has been launched in Northamptonshire, in a collaborative effort from Northamptonshire ICB’s Population Health team, Northamptonshire Healthcare NHS Foundation Trust, Northamptonshire Black Communities Together, Docobo Ltd, and eight community partners.

The programme will target health inequalities experienced by Black communities living in high deprivation areas across Northampton and central Wellingborough, offering pathways to diagnosis and treatment for conditions such as atrial fibrillation (AF) and hypertension. To date, the project has tested 426 people, identifying 5.9 percent as having potential AF, and 32.4 percent as having high or very high blood pressure.

Pratima Dattani, CEO of Support Northamptonshire hosting Northamptonshire Black Communities Together, said that the project has been “very helpful in raising awareness of atrial fibrillation and hypertension, and we have received positive feedback from the communities who attended the sessions. This approach has been innovative in engaging community champions from different Black communities who have reach and can engage people so that more people can gain access to screening and information.”

New elective care hub cuts waiting times for operations in Hertfordshire and West Essex

Plans for a new elective care hub have been approved in Hertfordshire and West Essex, which will see two new operating theatres open at St Albans City Hospital open in late 2024, to treat patients waiting for hip and knee surgery, spinal injections and ear, nose and throat (ENT) procedures.

Now that planning permission is in place, the design for the hub will be finalised, and the business case will need to be approved by the boards of the four NHS organisations working on the project: East and North Hertfordshire NHS Trust, Hertfordshire and West Essex Integrated Care Board, The Princess Alexandra Hospital NHS Trust and West Hertfordshire Teaching Hospitals NHS Trust.

Marie Lyons, consultant ENT surgeon at The Lister Hospital, said: “Elective care hubs are being developed across the country, concentrating on a defined set of non-complex procedures that can be delivered efficiently. Our hub is a partnership project and will draw on the best clinical practice across three hospital trusts to provide patients with a first-class service in modern buildings.”

Delegation of specialised services to ICBs across East of England, Midlands, and the North West

The NHS England board has approved plans which will see the commissioning of “appropriate specialised services” to ICBs in the East of England, Midlands and the North West regions of England. This approval is part of “a careful and considered approach to delegating full commissioning responsibility across England for appropriate services by April 2025”.

The new arrangements will apply to 59 specialised services “deemed suitable and ready for greater ICB leadership” by the NHS England board, with plans for others to “potentially follow in April 2025”.

Future of inpatient mental health and assisted conception services in Staffordshire

Staffordshire and Stoke-on-Trent ICB has approved a recommendation to make the change to mental health services at St George’s Hospital, Stafford, permanent, as well as to implement an “interim aligned policy to make the criteria for accessing assisted conception services the same across the whole of Staffordshire and Stoke-on-Trent”.

Chris Bird, interim chief transformation officer for the ICB, said: “Making sure that people get the right mental health care in their local community is our priority, but when someone needs to be admitted to hospital for their mental health, it is important that they do so in the most appropriate facilities.”

Noting that a previous fire at the George Bryan Centre necessitated a review of how these services are delivered, Chris added: “There is now much improved mental health provision in the area impacted, and that means inpatient provision is only required in the most serious cases. We have accepted that this means patients who require inpatient treatment are best served by the St George’s Hospital in Stafford which has been used as an interim measure since 2019.”

On the interim policy for assisted conception services, Dr Paul Edmondson-Jones, chief medical officer for the ICB, said: “As an ICB, it has been a key focus to make sure that everyone has the same access to services across Staffordshire and Stoke-on-Trent. We will revisit the policy when we have further national guidance through the Women’s Health Strategy and updated National Institute for Health and Care Excellence guidance on fertility, which is expected next year.”

Also on ICS-level developments, earlier this month we looked at some of the ways that ICSs across the country are tackling children’s and young people’s health.