There is no alternative but to work together, to integrate and to innovate in the NHS, writes Niall Dickson 

Integrated care

Across the NHS leaders are struggling to drive forward a new integration agenda, while coping with anachronistic legislation, incentive systems, and performance management, as well as ever rising demand.

Even with the extra 3.4 per cent real terms annual funding promised to oil the forthcoming NHS 10 year plan, there must be a real question about what can and cannot be achieved. It may not be fashionable to say it, but realism needs to be at the heart and centre of the plan, if past errors are to be avoided.

The NHS Confederation announced that we are setting up a regional team to work with Sustainability and Transformation Partnerships and Integrated Care Systems across England to foster collaboration and joint working, and support the spread of learning and best practice.

Whatever the final model or models that develop, we can at least all agree that integration must be a key organising principle going forward. Our new team will be there to support the long hard journey ahead to make integrated health and care services a reality on the ground.

Systemic challenges

There is now a general consensus that the challenges facing us are mostly systemic not organisational – we have to develop services that reflect the interdependencies that span across the NHS, local government and the diverse range of providers who deliver care.

There is agreement too that local cooperation between health and care leaders that focuses on practical change in neighbourhoods and wider areas will be key if we are to meet the rising demand from the growing number of frail and vulnerable people living in our communities.

Networking, peer learning and support offer the potential to galvanise local systems and we know from other industries the creativity that working in this way can release

The reality is that, in spite of that interdependence being well understood, we have still barely begun to join the dots in many parts of the country. Relationships in too many places are strained and whatever the ambition, there is an inability to move beyond words to genuine collaboration. While this persists, progress towards the integrated model will not progress, or at least not at the rate that is required.

As long as it is not a list of spending priorities based on special pleadings, the NHS Plan has the potential to be a key driver towards better linked services with rational supply chains. But the plan will need to articulate the scale of change required and set those realistic expectations. Our view is that it cannot be a panacea, but it can set the framework in which local leaders can start to transform the way services are run, not just a in a few areas but everywhere.

Our regional team is clearly a limited intervention that cannot on their own solve these significant challenges but we hope they will provide an independent, safe space in which local leaders can air and share the challenges they face, spread ideas and look together at possible ways forward. Networking, peer learning and support offer the potential to galvanise local systems and we know from other industries the creativity that working in this way can release.

This support will be particularly important for the areas where partnership working is less well developed yet they are facing pressing local needs – whether significant health inequalities, population health challenges or service change that has stalled and failed. In many communities deprivation and worklessness pace intolerable pressures on health and care services and it is only through local growth and prosperity strategies that these pressures can be addressed.

Other local systems face deep and long standing problems in the health and care services they offer and where people have lost faith in their ability to tackle them. Such systems also often experience a frequent churn in senior leaders who are overwhelmed by the scale of the challenge.

Equipping system leaders with the support of their peers is not only about an exchange of learning but also providing confidence that they can succeed. We must do all we can to ensure we do not end up with a two tier model whereby communities with poorly developed partnership working endure poorer services and unhealthier lives.

The latest evidence from the Lancet suggests that over the next 10 years there will be a doubling in the number of very old people requiring 24/7 care. Another stark reminder that there is no alternative but to work together, to integrate and to innovate. Our new team will be keen to do just that.