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ICSs must show value in tackling health inequalities, study says


By James Hacker
23 February 2021

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Integrated Care Systems (ICSs) will need to outline how their partnership working can support and ‘add value’ to tackling health inequalities, a report has said.

The report, Integrated Care Systems in London, published by The King’s Fund yesterday (22 February), found that Covid-19 had fostered a high commitment among London-based system partners to work on addressing health inequalities.

To do this, it suggested that ICSs will need to ‘be clear how partnership working at this level can support and add value to borough-based work on health inequalities’.

Efforts will need to focus on mental health inequalities, for example, which it said are ‘likely to widen as a result of the pandemic’. An NHS England analysis found that demand for adult mental health services could be expected to rise by up to 40%.

The study, commissioned by the Greater London Authority (GLA), examined the development of the five ICSs in London, by considering their long-term health plans and how they were changed by the pandemic.

Health disparities

London’s complex health system – with 33 local authorities, NHS commissioners, NHS providers and voluntary sector organisations – has meant determining how these bodies can best work together has raised a ‘longstanding question’, the report said.

London also contains seven of 10 local authorities with highest level of deprivation among older people in England, while life expectancy varying borough-to-borough by 15 and 19 years for men and women respectively.

Additionally, the health inequalities facing members of BAME communities have been exacerbated by the Covid-19 pandemic.

To address this, borough-based partnerships should co-ordinate local action tailored to their communities, the authors suggested.

The study also flagged that NHS organisations are major employers, and that this could be a means to ‘counter the economic and social damage inflicted by the pandemic on communities across London’.

Keeping momentum

The Covid-19 pandemic has meant that ICS leaders had more frequent contact, and temporary changes to national requirements allowed for ‘rapid progress’ in developing working partnerships, the report found.

It also said that while joint-working during the pandemic has improved local governments and NHS leaders’ mutual understanding, ICSs must recognise that these gains could be lost if pre-pandemic barriers like top-down management or funding are not addressed.

The authors cautioned that ICSs will have to work to ensure that this progress is not ‘undone’ after the pandemic.

The report noted: ‘NHS, local authority and voluntary sector partners will need to continue the practical focus seen during the pandemic – delivering joint initiatives and implementing tangible improvements to service.’

ICSs should also have a ‘breadth’ of leaders across the system to reduce dependence on limited numbers, it said, and reported that many primary care leaders did not always feel ‘closely involved in collaborative work at ICS level’, and that system leaders should focus on removing this barrier.

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