Background and context
Integrated care system (ICS): Somerset ICS
Number of places in the ICS: One place, coterminous with the ICS
Key partners in Somerset:
- Somerset NHS Foundation Trust, delivering acute, community and mental health services
- Yeovil District Hospital NHS Foundation Trust delivers acute hospital services for people mainly living in the south of the county; Yeovil and Somerset NHS Foundation Trusts are operating with a shared leadership team and plan to merge in April 2023
- ambulance services are delivered by South Western Ambulance Service NHS Foundation Trust
- Somerset County Council, which is co-terminous with the ICS, also works with four district councils. In 2022 it was confirmed that would merge with the district councils in the footprint to establish a unitary authority in April 2023.
Key features of the Somerset population:
- Around 600,000 people
- relative to the rest of England, the population is older, more geographically dispersed, and less deprived, although there are substantial inequalities with pockets of deprivation in some urban and coastal communities in Somerset.
Role of the trusts at place
The two trusts in Somerset have played a critical role in shaping and implementing the ICS’s strategic priorities. Plans to establish a single integrated trust – spanning acute, community and mental health services (and directly delivering some primary care) – for the ICS aim to stabilise services, address unwarranted variation, drive up clinical quality and develop new community-oriented care models. The trust will be unique in the breadth of services it delivers to a whole ICS population, and may be well-situated to assume further responsibilities for driving greater integration across NHS services, and with local government services in future.
Decision-making arrangements
In organisational terms, Somerset is a comparatively simple system. From April 2023, the ICB will be co-terminous with a unitary local authority, and the county’s acute, community and mental health services will all be provided by a single trust from April 2023 (subject to the planned merger completing on schedule).
In Somerset, place and system footprints are the same. Functions often associated with place-based partnerships – leading joint work with local government, developing approaches to address inequalities and building partnerships with voluntary sector organisations – are led across Somerset. Partners are then focused on service delivery at a neighbourhood level.
To date, the Somerset ICS has set the strategic direction and shared priorities, promoting collaboration, and providing a forum for constructive mutual challenge. Key executive leaders from the statutory organisations within the system, including the trusts, primary care and voluntary and community sector, formed a sub-group to lead on implementing decisions agreed via the ICS board. A primary care board was established in 2020 to be a collective voice to general practice in the county, and the voluntary and community sector.
Building community-oriented capabilities is a central theme of the strategy and, in turn, neighbourhood working is a key feature of the change programme in Somerset. Multidisciplinary neighbourhood teams – developing an ‘integrated out of hospital offer’ – are bringing together primary and community services alongside voluntary sector partners, working with primary care networks in the area. The trusts are supporting this agenda through how they deploy their community nursing capabilities, mental health and dementia support for older people, and deepening collaboration with Somerset County Council on intermediate care.
Looking to the future, the system-level integrated care partnership (ICP) for Somerset has an opportunity to articulate a shared set of outcomes across the NHS, local government and wider stakeholders. It is expected that the ICP and health and wellbeing board (HWB) will operate in concert, with the ICP potentially operating as a sub-committee of the HWB, supporting coordination with existing health and wellbeing strategy process, and informed by public health expertise and analysis held by the unitary authority.
Leadership model
Looking ahead, leadership capabilities in Somerset are likely to continue to be deployed largely at a county wide footprint and at neighbourhood level. The key executive leaders – in the trust, ICB and local authority – will continue to come together regularly to lead and coordinate implementation of change programmes.
To support this, the ICS envisages developing a shared delivery function that will lead on implementing an agreed set of programmes. Key capabilities will include programme management, transformation support, service improvement and communications. This function will initially operate as an amalgam of partners’ capabilities, with shared leadership and staff seconded by the key participating organisations – ICB, local authority and trust. In time it may be formalised and be hosted by a single partner organisation.
Approach to managing collective resources
In addition to complying with the national requirements of the Better Care Fund policy, Somerset CCG and the County Council managed several pooled budget arrangements in priority service areas including carers support and services for people with learning disabilities and/or autism. Disability services have been a long-standing area of collaboration and substantial budget pooling for the NHS and local government in Somerset. A joint commissioning board, hosted by the county council, has been in place for several years, overseeing resource allocation decisions, accountable to both the County Council and CCG. Somerset ICB will take on these arrangements in 2022/23; discussions are ongoing about how best to evolve joint planning arrangements in Somerset within the new legal framework.
Benefits and learning
The development of the ICS in Somerset has not been without challenge. However, system partners have been working closely together to improve outcomes, access and experience for the local population. For example, trusts and partners working in the Somerset ICS have developed a shared strategy and framework for operational change, which is supporting practical collaborative initiatives to benefit patients – such as ongoing joint work to address delayed discharges and a programme of work to develop the intermediate care offer. The strategy also covers the ICS’s ambitions to improve the health and wellbeing of local communities and neighbourhoods. An example of this work is encouraging people to develop networks of support, particularly for vulnerable groups.
Developing ways of working between Somerset NHS Foundation Trust and Yeovil NHS Foundation Trust are broadening the capabilities deployed in neighbourhoods across primary and secondary care. This collaboration will provide a simplified access route for local people needing primary health services, social care support and wellbeing support.