Integrated care systems and end of life care: an ideal match

Categories: Care and Leadership.

In the first of two articles about working as part of an integrated care system, Mark Jarman-Howe, chief executive of St Helena in North Essex and CEO Lead for the North East Essex Health and Wellbeing Alliance, explains how the hospice is forging partnerships to improve access to end of life care.

Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems (ICSs) are an increasingly important part of the health and social care landscape in England. To effectively build partnerships to improve palliative and end of life care access and outcomes in local areas will require hospices, and others with a similar mission, to engage with these emerging entities. This has been, and continues to be, an ambition/objective of mine and St Helena’s, and this feature outlines how we are working to achieve this.

Whilst the NHS Long Term Plan is a missed opportunity to set out a more ambitious and explicit national vision for palliative and end of life care, there are many aspects of the Plan which offer levers and opportunities for hospices to influence their local priorities. In particular, the move toward ever more integration of care is a key aspect of the new NHS Long Term Plan.

In North East Essex, St Helena has worked closely with commissioners and other health and care providers over several years to increase both our reach and impact. This includes implementing our SinglePoint 24/7 palliative care coordination centre and the My Care Choices register, our successful local EPaCCS (Electronic Palliative Care Co-ordination Systems) solution. We have experience of joint commissioning with health and social care, and have been a lead provider managing contracts with other providers on behalf of the system.

We see deep and meaningful engagement with our local STP, which will become one of the first ICSs in the country, as a logical evolution of our approach. For us, one of the best ways to achieve this has been through the North East Essex Health and Wellbeing Alliance. The Alliance is one of three local Alliances within our STP. As part of Essex there are also strong ties with the public health, social care and wider economic development strategies of Essex County.

The Alliance is a collaboration of organisations dedicated to improving the health and wellbeing of the population, committed to working together as an integrated system. It was formed in early 2018 with the following membership: the acute hospital, the Clinical Commissioning Group, the community services provider, the local GP federation, mental health trust, the Ambulance Service, Essex County Council, Colchester Borough Council, Tendring District Council, our local Community and Voluntary Service organisations, and St Helena.

It aims to transform the health and wellbeing of the population of North East Essex by creating a sustainable system of health and wellbeing services that meet the immediate and longer term needs of the population. All of us involved are unanimous in our recognition that achieving this ambition requires understanding of, and investment in, the full determinants of health, working with the widest range of partners in developing and designing locally tailored solutions.

As the STP transitions to a functioning Integrated Care System aligned with the NHS Long Term Plan, the Alliance will play an integral role in this.

There are two inter-related elements in the development of the Alliance:

  • The development of integrated strategic ‘place-based’ commissioning of health and wellbeing services
  • The development of integrated organisation and delivery of health and wellbeing services. This, in time, will combine integrated operational management of core services with integrated service transformation functions.       Transformation activities will be the priority in the first instance.

Combined, these two complementary developments will, in time, support the following:

  • A single capitated budget.
  • A move toward medium to long-term contracts, enabling providers to collaboratively design, plan, develop and deliver services with the aim to improve population health and wellbeing over a prolonged period.
  • Investment in prevention and pro-active activities where benefits are typically realised in the medium to long term and to share in the associated savings from these investments.
  • Alignment of priorities and incentives across providers ensuring they are working to shared goals and objectives that benefit the population and the system.
  • Organisations involved in the delivery and commissioning of care and support services working together to provide joined up, better coordinated care.

However, the Alliance also recognises that this is a long term vision and the transition must be managed carefully with membership and governance evolving over time to accommodate this transition. To support this transition Alliance partners have agreed to adopt the following principles:

  • Putting the needs of the population and the system above organisational priorities
  • Communicating clearly and listening to each other, our staff and to our population
  • Adopting a culture of trying new ideas and solutions
  • Delivering change, moving forward together – recognising the importance of all partners
  • Open, honest and transparent working at all levels, across all organisations

All of these are principles that play to St Helena’s strengths and we have been able to capitalise on our long-track record as system leaders and effective partners to be able to ‘punch above our weight’ within the Alliance. To the extent that as hospice Chief Executive I have now been appointed as the CEO Lead for the North East Essex Health and Wellbeing Alliance.

In a second feature I will share more about how we’ve been able to take forward our vision of an integrated end of life care model for North East Essex.

For more information visit St Helena

Read part two of this blog here