This spring, all the NHS 42 Integrated Care Boards (ICBs) in England are meant to engage upon their Five Year Forward Plans.
It is the first time they will do it under the new legislation, so they have been given an extra three months to comply. The exercise now is due to complete by 1st July.
For various reasons, however, this massive and demanding task will go to the wire, and there will be an almighty scramble towards the end of this period.
The NHS five-year plan
The facts are that Integrated Care Boards must produce plans of immense complexity.
To do this, they must work closely with a long list of individuals and organisations that includes all their partners, service providers, neighbouring ICBs and their providers, local authorities, as well as the voluntary, community and social enterprise sectors.
In addition to these ‘institutional’ stakeholders, they have to consult patients and the public (on average about a million of them) who are covered by their services. The sheer numbers are challenging.
Integrated Care Boards and stakeholders
Every ICB is different, but they all have a stakeholder list similar to this one from Norfolk and Waveney Integrated Care Board:
- 1 Ambulance Trust;
- 2 County Councils;
- 1 Foundation Trust;
- 2 Community Health Providers;
- 2 Health & Wellbeing Boards;
- 3 Acute Hospital Trusts;
- 5 Place Boards;
- 5 GP Provider groups;
- 8 District Councils;
- 8 Local health and wellbeing partnerships;
- 17 Primary Care networks;
- 105 GP Practices;
- 190 Community pharmacies;
- 572 CQC registered care providers;
- 1200 formal & informal charitable organisations.
Source: Transitional Integrated Care Strategy & Joint Health & Wellbeing Strategy 2022-2023
Stakeholder engagement
For many of these individuals and organisations, the dialogue over the Five Year plan is not a simple case of Yes/No. We are not in the world of quantitative surveys.
This is stakeholder engagement on matters absolutely critical to the delivered quality of future services.
What makes these interactions particularly important is that the integration agenda is proving harder than anyone thought.
This has been comprehensively exposed in a recent Nuffield Trust Briefing paper called People, partnerships and place: How can ICSs turn the rhetoric into reality (Jan 2023). In it, Helen Buckingham and her co-authors comment upon the difficulties that ICBs face:
“It will be imperative that ICSs have the skills and capacity to build relationships and trust at the place level and manage performance challenges in ways that do not recreate the behaviours and culture that came before them” (P 13).
They might well have added the need to equip themselves with full-functionality stakeholder management systems.
Only in this way can they record the ebb and flow of dialogue on the new ways that different planning, commissioning, and delivery organisations have to work together.
Just consider the range of topics that feature in a Forward Plan. For those that have inherited extensive public and patient involvement, or who have been quick off the mark with the 2023 engagement, the aspects of service under review are extensive.
Any one of them could realistically justify a full-scale consultation. In West Yorkshire, its May 2022 feedback report on a similar exercise was 100 pages long. The Black Country ICB's January 2023 public engagement exercise gathered feedback in no less than thirteen areas:
- Planned care & diagnostics
- Cancer
- Urgent & Emergency Care
- Out of hospital & community care
- Long-term conditions
- Preventing ill health & tackling inequalities
- Personalisation
- Primary care
- Maternity
- Children & Young People
- Climate change
- Digital
- Workforce
The data being gathered on relevant opinions is vast!
Now try to graft these on the process that has to happen before July 2023. Each ICB must engage on its plan in conjunction with the local Health & Wellbeing Board or Boards (HWBs) – and ensure consistency with the Joint Local Health & Wellbeing Strategies (JLHWSs).
Finally, approval must be sought from the Integrated Care Partnership (ICP) which will need to be sure that the views of the HWBs, Healthwatch and other stakeholders have been fully taken into account.
All this amounts to a tremendous workload for communication teams and engagement professionals, even if they have good systems support.
Delay factors
What makes it even more critical is the reality of three delay factors that will make everything last-minute this year:
- First, the inexperience of ICBs. They are in their first year.
Appointments to key positions are still being made, and many lack familiarity with the complicated guidance on public consultation and partnership working.
With regards to the Five Year Plans, many are learning on the job, and NHS England has labelled 2023 a ‘transition year’ and may be more lenient in its supervision of the process. But the plans are a legal requirement, and failure to consult on them might provoke a legal challenge. - Secondly, the workforce crisis, which was made so much worse by industrial action by nurses, ambulance drivers junior hospital doctors and others.
This seriously impacts the recovery plans so much needed to pare down the backlogs in elective surgery or outpatient referrals.
For once, there are reasons to work on the urgent rather than the important, and public information on the day-by-day situation seemingly takes priority. - Thirdly, outside London, the practice of purdah will inhibit much engagement and consultation until late May.
This prohibits much (not all!) public debate of controversial issues especially affecting local authorities where elections are about to be held.
Given the mandatory involvement of HWBs, there is an expectation that – as soon as they are able - many elected members will need to respond to constituents who are increasingly restive over shortcomings in health and social care. If a Five-year plan looks unconvincing, politicians will seek to block its endorsement.
In summary
Although many NHS plans are barely visible and rarely make the news right now, in many parts of England, they will have a significantly higher profile in the coming weeks.
For those who manage the NHS, there will be demands for more and better dialogue and an unprecedented focus on building and maintaining better relationships with local stakeholders.
