Hertfordshire and West Essex Integrated Care Strategy

About the integrated care strategy

The opportunity for change

Hertfordshire and West Essex are great places to live, work, learn and do business. Home to 1.6 million people and more than 60,000 businesses, we have many excellent schools and other local services. Many residents live in vibrant urban centres or in rural communities in stunning countryside.

In Hertfordshire and in West Essex there was already a strong tradition of partnership working prior to the pandemic. Mental health, learning disability and Child and Adolescent Mental Health Services (CAMHS) services for both counties are jointly commissioned by both local authorities and the NHS. There are established processes for joint commissioning in many other areas. The level of integrated commissioning and joined up service delivery accelerated significantly during the pandemic – particularly through the Hertfordshire Discharge to Assess (DTA) model for co-ordination of health and care support which allows people to leave hospital as soon as they are fit to do so and the integrated delivery of adult mental health services in Essex.

New integrated care systems build on that spirit of collective purpose, decisive action, and innovation that we saw during the pandemic. ICSs are partnerships of organisations that come together to plan and deliver joined up health and care services, and to improve the lives of people who live and work in their area.

The purpose of integrated care systems is to:

  • improve outcomes in population health and healthcare
  • tackle inequalities in outcomes, experience, and access
  • enhance productivity and value for money
  • help the NHS support broader social and economic development.

In Hertfordshire and West Essex we are already on the journey to develop excellent integrated working. Partners within the ICS are eager to scale up their ambition and to demand of ourselves that we work differently together to achieve a step change in health and care outcomes for our residents.

Partners within the ICS have come together to form the Hertfordshire and West Essex Integrated Care Partnership (ICP). The ICP is a joint committee, established by the Hertfordshire and West Essex Integrated Care Board, Essex County Council and Hertfordshire County Council, to improve health and care in Hertfordshire and west Essex. It is a statutory committee, that brings together organisations involved with improving the heath, care, and wellbeing of the population in order to facilitate joint action to improve health and care services and to influence the wider determinants of health and broader social and economic development.

The ICP provides a forum for NHS leaders and local authorities to come together as equal partners, alongside a broad alliance of organisations and representatives concerned with improving the health and wellbeing of our population. It allows system partners to agree shared objectives, work on joint challenges, and support places and organisations that comprise the system in the interests of people and communities.

 

Scope of the strategy

Our integrated care strategy sets out our vision, scope, and approach. Drawing on the assessed needs from the Hertfordshire and Essex joint strategic needs assessments, it outlines how we will work together as a system to improve the health and wellbeing of people living and working in Hertfordshire and West Essex, including increasing the years that people live in good health and reducing the gap between the healthiest and the least healthy in our community.

Our approach recognises the importance of health and care services for health, and also that health is the result of a complex interplay of factors that include our friends and family, our neighbourhood and community, as well as wider influences from education, employment, housing and other areas, as outlined below.

The following video from The Health Foundation, titled What makes us healthy?, explains how our health is linked to our environment and other social factors. 

 

The other influences on our health and wellbeing are further outlined below in Figure 1 and the Robert Wood Johnson model (Figure 2), which provides a framework that recognises these factors and the need for us to tackle all these elements focussing on those that both have the biggest impact on health and are amenable to system action.

Infographic from The Health Foundation illustrating factors that influence health and wellbeing. Factors highlighted are living and working conditions, social and community networks, behavioural factors, and age, sex and cultural factors

Figure 1 - The factors that influence an individual’s health and wellbeing (source: The Health Foundation, 2019)

Infographic illustrating health status ranking model developed by the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute. Infographic shows that our health is influenced by socio economic factors (40%), health behaviours (30%), clinical care (20%) and built environment (10%).

Figure 2 - Health status ranking model (source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute)

 

Our strategy outlines how we will do things differently, whether by accelerating the pace of integration already underway or by identifying new opportunities to join up health and care. It also sets out how we will reach beyond services to join up work with local authorities and the voluntary and community sector on other things that influence health, such as employment, housing, and education.

The strategy sets out six strategic priorities for integrated work across the system. Each priority describes the outcomes we are seeking to achieve through this strategy. Delivery will be supported by the ICB five-year Forward Plan and by the strategies and plans of the county councils and other system partners.

We have taken the decision as a system to only focus on a few specific priorities, where there is the greatest need, and we can have the biggest impact by delivering collectively as a system. We recognise that system working is complex, and it is therefore better that we focus on a few areas that we do well together than trying to do a large number of things and risk failure. This does not mean the areas of needs not covered in this strategy will not be delivered. On the contrary, these will continue to be delivered through the organisations in our system as business as usual.

Our strategy also does not include the usual business that partners are required to carry out as part of statutory responsibilities. For example, it does not set out the NHS’s responsibilities for meeting NHS England requirements, nor the County Councils’ statutory responsibilities for social care. These ‘must dos’ will be covered by operational plans and business as usual governance. Instead this strategy focuses on the interface between the responsibilities of the NHS and local authorities for joined up planning, commissioning, and delivery of care for the local population.