Integrated Care System
There are currently 12 acute hospitals in NWL, organised into four Trusts. In addition there is a single specialist Trust, the Royal Marsden, as well as the Royal Brompton Hospital and Harefield Hospital which are both specialist hospitals.
In spite of many previous attempts to create greater alignment of services and improve the quality of care across the acute sector in NWL, there remain variations in quality and operational performance which increases the inequity of access and outcomes for the population of NWL.
In NWL ~ 51% of the healthcare budget is spent on acute care services. This compares to 50% across the NHS. Despite this higher level of spend on the acute sector, there is an underlying 21/22 financial deficit of 9% of income. Deficits are not evenly distributed between Trusts, which, in past years, have had differential success in delivering improved performance in part due to differing infrastructure.
At the same time, there are considerable opportunities for the acute sector to play a significant role in the development of place (Borough/PCN) based systems focusing on greater collaboration between health and care partners, the voluntary sector and volunteers, leveraging their role as anchor organisations to create employment opportunities and reduce inequalities. This will require new ways of operating between organisations that have traditionally not shared resources and a much greater understanding about resource allocation that aligns with population need.
The wider health and care system also has the opportunity to capitalise on partnerships with academic organisations and the wider economy to further research and innovation which can be tested and evaluated in ‘real life’ situations. These relationships are already in place, but there is scope for greater innovation through greater shared learning and sharing of resources.
Moving toward greater collaboration across the acute sector in North West London
The NHS Long Term Plan signalled a move to greater integration of care and this was strengthened by the Government Bill published on 6th July 2021. The draft proposals suggest that there should be greater collaboration at place (PCN/Borough) level and between acute care providers. NHSE/I published guidance in June 2021 on how Trust collaboration models may be arranged. Group and Chain models of care were proposed in the Dalton Review and have been established with some success in other parts of England.
The last year has seen significant additional challenges for the NHS in NWL in responding to the impact of COVID-19. Acute providers across NWL have risen to this by working effectively together to address these significant challenges to keep patients and staff safe. Examples include:
- ensuring more consistent, equitable high-quality care across NWL through shared leadership teams/proactive clinical support
- operating services in more efficient and effective ways to improve throughput e.g., joint waiting lists, establishing surgical hubs, working together to share staff and resources to respond to the pandemic
- putting in place management and governance systems to support more collaborative working e.g. daily clinical and CEO calls
Local care providers, including community, mental health, primary care and social care, have similarly worked together and with acute providers to address significant challenges.
At the same time, the acute sector continues to face considerable challenges, not least a significant financial deficit. Addressing a deficit of this magnitude while increasing quality requires mature collaboration and different ways of working.
The learning from the last 12 months is that greater collaboration across acute providers would enable a continued focus on improving quality, efficiency and equality of care delivery.