In my previous blog I looked at the response of the three Integrated Care Systems (ICS) in Yorkshire to the growing financial insecurity faced by many people in this region. Each Integrated Care Board (ICB) received a paper which set out the context, rationale and in the case of two ICS made a number of recommendations for action.
As I said in the blog – it is so important to come up with quick practical actions that will make a material impact on people who are most effected by a toxic combination of poor health, financial insecurity and a reliance on NHS services between now and the next two years at least.
It is important that ICBs recognise that local government and the VCS are under terrible financial pressure and their situation is likely to get worse. So just referring more people through social prescribing to welfare rights and debt advice is worse than passing the buck – it is irresponsible unless funding for these services is found.
I have now looked at the minutes of each ICS which captures the discussions in response to the papers. A summary of all the minutes is available here
The big danger is that after an initial flurry the financial insecurity crisis will be largely ignored as NHS systems default to focussing on the very real demand and quality issues in the health system – ignoring the feedback loop between health and poverty and forgetting their ambitions to take a ‘population health management’ approach in an ‘integrated care system’.
There is a tendency to default having ‘interesting’ discussions but failing to agree practical strategic actions. If any board is commissioning work try to understand the problem’ or is hunting for ‘evidence of what works’, it’s a sign that they have avoided taking action.
West Yorkshire minutes
Chair reminded the ICB that the Integrated Care Partnership (WYPB) asked for a response in relation to alleviating poverty.
Recognition that the ICB had two potential roles – for staff and for citizens in West Yorkshire.
Practical examples such as Winter warmth investment and link to tackling inequalities.
Call for development session for ICB
Recognition that work was going ahead in each place and it would be helpful to have oversight and assurance for this work
Actions
Board members invited to contact the Chair and Chief Executive to join a Task and Finish Group to take forward actions identified in recommendations.
Humber and North Yorkshire
Actions
A letter has been drafted by the Chair and Vice Chair (not in public domain) which will describe actions that are taking place and setting out best practice with regard to impact.
The ICB is looking to secure clear evidence in terms of impact and is working with local universities with regard to this.
It is expediting the approach to social prescribing and work with regard to workforce and recruitment.
South Yorkshire
Noted a fast change environment and worsening situation with regard to inflation. Concerns raised with regard to impact on cost of prescriptions, need for signposting to debt advice by NHS, impact on winter planning.
Concerns re NHS workforce impact with 40,000 earning less than £25k, focus on areas of deprivation not sufficient – eg people with learning disability, impact on local economy.
Concern that leadership on this is not clear – view expressed that ICB role is not about dictating or providing answers but contributing to solutions. Important to learn from COVID. Importance of working in collaboration with VCS.
Actions
Place directors to consider practical responses and report to October development meeting – I think this means a private meeting.
My conclusions
ICS responses to the growth of financial insecurity in their populations is unclear. There is a real risk that instead of meaningful strategic actions we will see a default to traditional pathways that appear to involve action but make little difference to population health.
The red RAG ratings to watch out for are – an over emphasis on:
- Role of NHS as Economic Anchor
- Focus on staff pay and conditions rather than wider population actions
- Focus on Social Prescribing to the exclusion of welfare rights services
- The awful OHID guidance aimed at making NHS staff more poverty aware
Actions we need to see
First, identifying populations who are using the NHS and at risk of financial insecurity and commissioning integrated welfare rights/debt advice to run alongside clinical services for example:
- Major Trauma
- Head Injuries
- Motor Neurone Disease
- Cancer
- Muscular Dystrophy
- Multiple Sclerosis
- People with acute mental illness
Second, commissioning of sessional welfare rights/debt advice services to run alongside GPs serving the most deprived populations in each place.
What do you think?