Legislative powers and duties, and statutory guidance are important drivers of change. But they are not the only drivers, nor even the most important ones.
Culture change and collaborative leadership – System working to improve population health requires a collaborative culture in which leaders across the NHS and local government have an individual and collective responsibility to look beyond their organisational boundaries to achieve the best outcomes for their community. This requires time to develop trust, confidence and a shared understanding between leaders across places and systems, and a strong leadership development offer based on a peer-led approach.
A shared and single version of the truth – encompassing shared ambitions for health and wellbeing and addressing health inequalities, a shared evidence base on the challenges, priorities and assets of each system and each place and neighbourhood within systems. And a shared strategy that identifies how system, place and neighbourhood will work together to meet the challenges.
Common principles and expectations – Systems must have the freedom to determine their own priorities, models of governance and modes of delivery but these should be underpinned by clear national expectations of the common principles for all ICSs. These operating principles should be: demonstrable commitment to an all-age approach to population health, including children and young people’s health and transitions from CYP to adult services; an outcomes-focused approach to addressing health inequalities, engaging the wider determinants of health; adherence to the subsidiarity principle; and ensuring that all components within the system identify and deliver their contribution.
Implementation and development support – ICS, place and neighbourhood leaders across local government and the NHS and beyond will need support in developing a new culture and approach. The LGA already works with DHSC, NHSEI, NHS Confederation, NHS Providers, ADASS and ADPH to plan and deliver a range of sector-led, peer-led support and improvement offers. We need to build on the support already available and review, adapt and extend it, according to the development needs of leaders.
Single outcomes framework - and a shift to pay for outcomes rather than inputs to get the incentives right to prioritise the things that really matter.
Financial flows – We strongly support the presumption that unless there are explicit reasons, the majority of non-elective health and care budgets will be delegated to place level. We also propose greater alignment of local government and NHS resources at system level. Legally, local authorities cannot agree to spend their budgets in a different local authority area unless for a joint service. Therefore, alignment or pooling of NHS and council resources will almost always need to be at or within HWB footprints.