sir richard leese

ICSs: A new era for NHS collaboration with local government in England

After 25 years of being the Leader of Manchester City Council, in which he played a key role in the city’s regeneration, Sir Richard Leese is ready to be part of a health revolution that is about to hit England this summer.

As the first Chair of Greater Manchester’s Integrated Care System (ICS), one of 42 ICSs that will become statutory in July, he will play an instrumental role in a new era for integrated care in the region.

But what are Integrated Care Systems and what is the need for them?

ICSs are new partnerships between the various organisations delivering health and care needs across a specific area, with the purpose of coordinating services, improving population health and reducing inequalities between different groups.

Sir Richard says the four main aims of ICSs are to:

  • Improve population health.
  • Tackle health inequalities.
  • Create a more efficient value for money and high performing health service.
  • Take into account the wider social and economic contribution that health makes to an area.

With varying levels of integration across the country, some areas will see greater disruption due to the introduction of ICSs, however, this will not be the case in Greater Manchester, due to the region’s joint up approach to health in recent times.

Sir Richard credits this to the region’s devolution deal and the Greater Manchester Health and Social Care Partnership, which will make an existing voluntary arrangement a statutory one due to ICSs.

He adds: “So, it really just gives us more teeth to go further and faster with those things that all the partners and stakeholders in Greater Manchester have agreed that we need to be doing anyway.”

When asked about the benefits of an ICS for Greater Manchester, but also for other areas, Sir Richard says that it will strengthen their ability to lead on the population health agenda.

However, he acknowledges that getting a healthier population is only partially to do with providing health and care, he says:

“A lot of it's going to be about decent housing, decent [employment], getting more exercise, active lifestyles, improved diet, those things that local councils are far better placed to lead than NHS providers.

“I think this will give them the opportunity to take that lead supported by NHS providers.”

There have been some concerns that ICSs are a way to seize power from councils and sideline the voices of local communities, but Sir Richard disagrees, saying: “It’s certainly not happening in Greater Manchester.

“I don't think actually, it's happening anywhere, I think it's a bit of a myth to be honest.”

According to Sir Richard, ICSs are very much about place-based and neighbourhood-based approaches, which will ensure that councils are in the “driving seat” to make changes in their local areas.

The new setup will probably lead to “enhancing the role of councils rather than diminishing it,” he says.

Each of England’s 42 ICSs will be led by an Integrated Care Board (ICB) and an Integrated Care Partnership (ICP).

ICBs will be responsible for NHS functions and budgets and when established will replace Clinical Commissioning Groups (CCG), while ICPs will be a statutory committee, bringing together all system partners in order to produce a health and care strategy.

It will be the first time since the NHS was formed in 1948 that a nominated member of local government will be on a health board of this kind, with Sir Richard saying: “There are lots of ways that councils are not only able to take the lead, but also will be a very active part of NHS decision-making as well as their own.”

The arrangements in Greater Manchester are a prime example of this, as shown by Sir Richard’s appointment as the region’s first ICB Chair, while the Chair of the ICSs Audit Committee will also come from a local government background.

The area’s ICB will have a local authority representative and Greater Manchester Combined Authority’s (GMCA) Healthy Lives and Quality Care Lead, Councillor Brenda Warrington will be a full participant observer of the board.

Of course, the most important part of the NHS is its staff, of which there are around 1.2 million in England, so how will they benefit from the introduction of ICSs?

Sir Richard says: “I think we have to make it a benefit to NHS staff, hopefully by operating different ways will make the work more satisfying and more rewarding.”

In terms of planning for the next 12 months, Sir Richard says that the main priority of ICSs is to invest in the workforce, he adds: “If we want to improve the quality of our services etc., then we will need to invest in our workforce.”

A workforce “that is far more representative of the communities that we are serving” is a key aim of his, as this has a “fairly obvious benefit to people”.

In terms of the general public, Sir Richard is focussed on tackling health inequalities, which has really come to the fore during the Covid-19 pandemic, which he says is partly down to staffing numbers.

“If we improve population health, that's a benefit to local communities and if we provide services more efficiently and more effectively, that's another benefit to local communities,” he adds.

This introduction of ICSs feels like a major change in how local health policy is designed in England and Sir Richard hopes that the new framework will give the opportunity to try new approaches.

He uses Greater Manchester’s track record of using devolution to invest in research and innovation over the past five years as an example of how the region could benefit from ICSs, saying:

“When we've got clear evidence that things aren't working, we need to have that opportunity to innovate. We need to try new things.”

When asked where he thinks Greater Manchester’s ICS will be in ten years, Sir Richard thinks that due to their neighbourhood-based approach there should be better engagement between healthcare workers and other public sector organisations and agencies etc.

As well as this, he says that the first step in creating healthy communities is that people need to take responsibility for their own health.

But what indicators will Sir Richard use to measure if ICSs have been a success or not and what is the key criteria for this, he says:

“Life expectancy, school readiness, obesity, all of those sit on all of the criteria by which we measure happiness and wellbeing that Greater Manchester will have made significant steps forward.”

Looking to the future, Sir Richard is committed and fully focussed to making positive changes in his new role:

“It's a real opportunity to do things differently and achieve results that we've never achieved in the past. So, for me to be able to concentrate on that and nothing else is great.”

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