Cllr Ketan Sheth

For those councillors in local government who scrutinise the NHS, it seems to have become an expectation that as one great change ends in our local health services, another begins.

A good few years ago in north-west London we saw the start of the Sustainability and Transformation Plans (later rebranded as Sustainability and Transformation Partnerships) or STPs as they were widely called. Now it seems another change is on the way. By April 2021 an Integrated Care System (ICS) will have been introduced, taking forward much of what was developed by the STPs. And, they are coming at a time of incredible change for the NHS and local government as a result of dealing with the Covid-19 pandemic.

I’m sure many of you are familiar with an ICS. If I had to summarise, I would say they are in essence bringing together health providers and commissioners, along with local government, to plan healthcare based on local population health needs in a defined geographical area. I’ve noticed the term ‘place’ features frequently in the NHS documentation and published reports. I should say as well, that the underpinning and thinking for them is all set out in the NHS Long Term Plan. In a few areas such as Greater Manchester, they started in 2018, and more have been set up to the point where around half of England’s population is now covered by an ICS.

As for my local proposed ICS, this will be cover around 2.3million residents across eight London boroughs in north-west London stretching from Westminster out to Hillingdon, with multiple providers, and community healthcare Trusts as well, and not to forget, the local authorities. At the moment, each borough has its own clinical commissioning group (CCG), but the plan is for one CCG to cover the whole area as well (but that development is best discussed at another time) across the eight boroughs.

So, what I want to address here is this – how does an elected member sitting on an overview and scrutiny start to grips with effectively reviewing and holding to account the development of a ‘system’ of such complexity, and in the constraints of the time and resources we all know elected members face? What should our starting principles be? It’s not easy to answer, but I have a few suggestions.

As an elected member, I don’t necessarily need to worry about being a ‘systems thinker’ but I do like to test the local ICS thinking constructively. I would perhaps ask this – thinking about the ordinary residents in my ward what will it deliver for them? What will an ICS do to make them and their families and children healthier, and be able to live longer and with a better quality of life? Ultimately, for me that’s what organisational systems in our public services should be about. Simply, a means to an end of delivering something better for ordinary people and our communities.

Also, while we talk about ‘systems’ in health services, let’s not forget that when we refer to hospitals in particular we are talking often about important local institutions which command a lot of local pride and attachment; not just because of the services they provide, but because of the outstanding research they do. Also, in my home borough of Brent, they are important local employers. I think this way of looking at the world from the grassroots should not be lost in these changes.

So that’s a few ways we can start to get to grips with such a big change, and complexity. Then it might be time to prepare for the next one, whatever that may be.

Cllr Ketan Sheth

Chair, Brent Council Community and Wellbeing Scrutiny Committee