Pillar 4: An integrated health and care system

Cheshire West ‘Place’ is one of nine places within the Cheshire and Merseyside Integrated Care System (ICS). The ICS’s purpose is to ensure that the people of Cheshire and Merseyside become healthier and continue to have access to safe, good quality and sustainable services. The ICS also has a key role to play in reducing health inequalities, through the Core20PLUS5 programme but also more broadly, for example, though its sustainability and Green Plans.

The ICS was as a statutory body on 1^st July 2022 and includes the NHS Cheshire and Merseyside Integrated Care Board (ICB) and the NHS Cheshire and Merseyside Health and Care Partnership (HCP).

The Cheshire and Merseyside ICB is responsible for the day to day running of the NHS in Cheshire and Merseyside, including planning, buying healthcare services, and taking over the functions of NHS England such as community pharmacies and dentists. The ICB arranges for some of its functions to be delivered and decisions about NHS funding to be made in its nine Places, through Place-Based Partnerships. The ICB is accountable for NHS resources deployed at Place and has created a system-wide Joint Forward Plan to support this. The NHS Delivery Plan section of this Joint Forward Plan describes how NHS Cheshire and Merseyside, partner NHS Trusts and wider system partners intend to work together to provide financial sustainability whilst providing safe high-quality services to meet our population’s physical and mental health needs. It has a triple aim to:

1. improve the health and wellbeing of our population
2. improve the quality of services
3. make efficient and sustainable use of NHS resources.

The Health and Care Partnership provides a forum for NHS leaders and local authorities to come together as equal partners alongside other stakeholders from across Cheshire and Merseyside. The Cheshire and Merseyside Health and Care Partnership has generated an All Together Fairer Health and Care Partnership Plan 2024-2029 to address the wider determinants of health and improve health and care outcomes.

Health and Wellbeing Boards (based on a Place/Local Authority footprint) will continue to develop the Joint Strategic Needs Assessment and the Health and Wellbeing Strategy. Unlike other Places in Cheshire and Merseyside, for Cheshire West, this Place Plan is the Health and Wellbeing Strategy. The delivery of the integrated health and care system pillar is overseen by the Cheshire West Health and Care Partnership Committee, who regular report progress to the Health and Wellbeing Board.

Like other Places, the Cheshire West health and care system is tackling increasingly complex health issues experienced by our population. The system was not designed for people with multiple conditions using multiple services. The complexity of people’s health issues today means services need to be designed and integrated around an individual’s needs rather than around separate organisations. We also recognise the key role of the Community Sector in delivering health and care services. We want to work with people locally to jointly shape services, improve the quality of care, decrease health inequalities, and make sure that services are financially sustainable for the future.

Partners across the borough, including the NHS, Local Authority, the Community Sector and Healthwatch are working to integrate care, with a focus on prevention, supported self-care and delivering personalised care closer to home. In this way, local people will benefit from services which are easier to access, better organised, more joined up and, most importantly, targeted to their needs. The aims of a more integrated approach are to:

• improve population health
• improve healthy life expectancy
• reduce health inequalities
• transform the experience and quality of care
• ensure the sustainable delivery of health and social care.

Our seven Community Partnerships are key to the success of this work. Community Partnerships are about the local community, bringing together organisations that aim to transform, develop, and deliver community health and social care services. They include the local GP network (known as the Primary Care Network), and the wider primary care team, including Community Mental Health Teams, District Nurses, Occupational Therapy, Community Physiotherapy, Midwives, Dentists, Opticians, Pharmacists, and other community specialists. There is also representation from local people themselves, and the Community Sector.

Our Community Partnerships take into account the whole community. This includes others who have a significant role such as Social Care, Public Health, Education, Town Planners, Local Employers, Third Sector, Local Sports Groups, Town and Parish Councils and of course the Communities themselves. The Community Partnerships help to influence the arrangement of care and support innovative health solutions in partnership with the local community that suit the needs of a whole population and takes the views of all these stakeholders into account. Within Cheshire West, this programme is particularly innovative as it is led by the VCFSE sector, who have an equal place at the Partnership table.

We will:

• develop and publish a more detailed action plan, to sit under this Place Plan, with joint leadership from health and care, based on local data, intelligence and by taking resident views into account. This will focus on shifting support from treatment to prevention, care from hospital to community and technology from analogue to digital
• continue to develop our approach to population health management, using data and analytics to prevent ill-health, address health inequalities, and identify those residents who are at higher risk of their health deteriorating, enabling us to deliver preventive interventions
• pursue environmental sustainability and health equity together
• continue to develop and formalise integrated ways of working across the Local Authority, NHS and other providers in Cheshire West
• share Local Authority and NHS prevention budgets and greater NHS percentage investment in upstream, prevention of ill-health, with annual monitoring of spend
• join up care pathways across the Council, the NHS, and the Community Sector
• redesign local services as necessary, with a focus on our agreed integration priorities of Integrated Communities, Mental Health, Learning Disabilities and Neurodiversity and CVD Prevention
• develop closer relationships with the residents in our communities
• support the development of our seven Community Partnerships
• strengthen involvement of the Community Sector in care community delivery, supported by increased and longer-term funding, to build community resilience
• tackle the backlog of community services, diagnostics, and elective care, improve women’s health outcomes, neonatal and maternity care services, reduce long waits and improve performance against cancer waiting and diagnosis time standards, screening uptake and other areas of priority, resulting from the COVID-19 pandemic
• increase people’s experience of being offered a choice of healthcare provider
• continue to deliver the NHS influenza, respiratory syncytial virus (RSV), and COVID-19 vaccination programmes for those eligible and meeting the needs of patients with these conditions
• improve the responsiveness of urgent and emergency care and build community care capacity– keeping patients safe and offering the right care, at the right time, in the right setting
• improve timely access to, and experience of primary care (including dental activity), palliative and end of life care by ensuring individuals have a comprehensive support plan
• improve mental health services and services for people with a learning disability or neurodiversity – maintaining continued growth in mental health investment to transform and expand community health services. This includes improving local access and reducing Out of Area placements/accommodation, as well as increasing uptake of relevant health checks
• increase diagnosis of dementia to improve access to relevant services
• exploit the potential of digital technologies to transform the delivery of care and patient outcomes – achieving a core level of digitisation in every service
• work in partnership to improve sustainability of spend on NHS and Local Authority services.