As well as creating new structures, the reforms underway within the NHS will see a considerable movement of people and power across the new Integrated Care Systems. Wilmington Healthcare’s Victoria Paxman looks at how the landscape of key influencers and decision-makers will change as a result.
For all the talk of major structural change in the NHS, we shouldn’t forget that it’s ultimately people that make decisions, not institutions. As a result, one of the most important things industry can do is keep a watchful eye on the movement of people within the NHS and the changing context of their roles.
The demise of Clinical Commissioning Groups (CCGs) and the development of Integrated Care Systems (ICSs) will, over the coming months, see thousands of NHS professionals taking on new roles within ICSs – drawing in new priorities and a different contextual environment in the way they make decisions.
But in this volatile, fast-moving period of change, what do we currently know about how the reforms will shape decision-making and personnel at the top of the structure (system level), and who will be the key customer contacts that industry need to put at the forefront of their engagement plans as a result?
The ’apex’ decision-makers
Certainly, we now have a clearer picture of the composition of the ICS Board (also sometimes called the NHS Body Board), thanks to the Design Framework published by NHS England earlier this summer.
Statutory roles for this body will be: the Chief Executive, Chair, Finance Director, Medical Director and a Director of Nursing, as well as up to three non-executive directors and partner members representing local authorities, trust providers and general practice. These are ‘apex’ decision-makers who will shape strategy and allocate resource at a system level.
Another key component will be the ICS Partnership Committee, also sometimes called the Health and Care Partnership board. The ICS Partnership Committee won’t be a statutory body, but should be made up of equal representation from local government (covering both public health and social care), local NHS and other stakeholders specific to the system requirements, most likely including voluntary and community service participation. It will have a chairperson and will play an important advisory role within the ICS, supporting the board and ensuring a wide range of voices across the health and care landscape are properly represented.
Other important players within the ICS landscape will include a Digital Transformation Lead, responsible for the system-wide data and digital transformation programme; a Director of Communications and Engagement (sometimes Corporate Affairs), responsible for defining, planning and delivering communications and managing relationships with stakeholders across the system; and the Workforce Lead which is responsible for system-wide workforce decision-making.
Higher commercial stakes
There are three important points to remember in all of this: the first is that it’s going to be a complex and changeable picture – we’ve covered the implications at system level, but there will also be a changing customer landscape at place and neighbourhood levels, as provider collaboratives and primary care networks continue to develop.
Second: there will be variability around the country even after the reforms “land” in a statutory sense from April 2022. The Design Framework provides some of the core features expected within ICS governance but it allows latitude for systems to evolve organically to meet local custom and practice. The same is true with provider collaboratives, where there are already a range of different models developed, as set out in this recent guidance.
And third: the core ethos of all of these changes is angled towards increasingly collaborative and networked decision-making. This means that there will be a natural interplay and overlap between membership of decision-making units at system, place and neighbourhood levels.
The stakes will be higher too. As Wilmington Healthcare’s Content Director Oli Hudson has explained, industry will have to take a broader approach to engaging clinical decision-makers: it will no longer be enough to consolidate your hold on a handful of clinical advocates when ICSs will increasingly be making collective decisions spanning the whole footprint. Large contracts to bring together health records across a system, as signed recently in Lancashire and South Cumbria, reflect the larger commercial opportunities on offer.
Of course, all of this means knowing who does what matters hugely. Wilmington Healthcare has been working to gather comprehensive coverage of key ICS personnel and stakeholders, as well as Primary Care Networks and their key decision makers. We are also fast developing databases covering Place-Based Provider Collaboratives (also sometimes referred to as Place-Based Partnerships), detailing who they are and how they are integrated.
In short, from a personnel perspective, the kaleidoscope has been shaken by these reforms. It’s vital that industry learns where the pieces have now fallen, so they can make sure their engagement approach matches these new realities.
Wilmington Healthcare can provide the granular data needed to identify and target key decision makers across the new NHS, find out more.