Integrated care systems: opportunity and challenge
01 July 2022
As Integrated Care Systems come into force across England, David Jones considers how the Point of Care Foundation can support the transition to integrated care with increased equity in the support available for staff across the system.
Topics
Integrated Care Systems (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. As of today, 42 ICSs covering the whole of England have been established on a statutory basis.
There is a lot to like in the intention of the new ICSs. It is the dream of many to bring health, social care and local voluntary and community sectors together in service of the health and wellbeing of communities, overcoming historical imbalances in funding and resources. There are also opportunities to create more seamless connections between the different parts of the health and care system and overcome some of the tribalism that gets in the way of so much good intention.
Experience suggests we should be setting our expectations to ‘low but hopeful’ given the huge challenge that will be involved in making sure these new partnerships deliver their promised benefits. However, we want to support the process. At the Point of Care Foundation we think the philosophy of integration that has created ICSs offers real opportunities for delivering better, more compassionate care for people and communities.
We are excited because these new partnerships bring an opportunity for more consistent and robust approaches to listening to communities and service users. We are working with two forward-looking ICSs (Cheshire and Merseyside Health and Care Partnership and Our Dorset ICS) to support them to ensure that their work is informed by the experiences of people and communities. This opens up the possibility of thinking more creatively of what it is that matters to people and communities, and design services around that.
At the Point of Care Foundation we think the philosophy of integration that has created ICSs offers real opportunities for delivering better, more compassionate care for people and communities.”
Schwartz Rounds and integrated care
High-quality care is built on positive organisational cultures and well-supported, motivated staff. Integrated care systems offer an opportunity to extend the support that staff receive right across the system, by enabling Schwartz Rounds (‘Rounds’ for short) to be established for staff working in health, social care and local voluntary and community organisations – many of whom haven’t previously had access to this kind of support.
Schwartz Rounds are confidential forums that allow all staff from an organisation or system to come together regularly and share the emotional experience of their work through the sharing of stories and collective reflection.
The evidence1, 2 shows Rounds increase empathy and compassion for colleagues and patients in those attending regularly. It does this by normalising the emotional experience of the work, creating a culture of openness, promoting connectedness, and increasing insight into the experience of other people. The ‘all staff welcome’ philosophy also allows the role modelling of openness to emotional experience as staff from all levels and all types of role in the organisation share their experiences.
We currently support 250+ organisations across the UK and Ireland to deliver Rounds and have heard many stories about how this process helps colleagues cross the divide between different professional and organisational silos, as they realise they are often working with the same or relatable experiences of their work.
Within the ICS, there is an opportunity for Rounds to provide a forum for colleagues from different sectors to find common ground and, through that, create opportunities for integration that may not otherwise emerge. There are important similarities and differences in the experience of sector colleagues, but the similarities tend to be understated while the differences are overstated. There needs to be a route through to a more realistic understanding if we are to see the benefits of integration come true.
We know that Schwartz Rounds can reduce levels of psychological distress experienced by staff who attend regularly, and it seems only fair that ensuring equity of access to this sort of support is a priority. We also know Rounds can bring about a shift in the culture of care by changing the way people experience, share and live with the emotional experience of their work.
By supporting staff more equitably across sectors, especially in social care and the third sector, we create the potential for more compassionate care in services providing for some of the most structurally disadvantaged groups in society. We also know that the staff in these services often have relatively few opportunities for formalised support. Rounds help build bridges between colleagues – strengthening relationships – and, as such, are a good fit with the ICS model.
There are two other opportunities that are driving our commitment to working at the system level. The first is to provide reflective space to colleagues in roles that rarely attract a focus on their wellbeing. The second is to provide support to the people that are caring for some of our most vulnerable and marginalised groups and communities. We believe these are equity issues and that it is the right thing to do to match the kinds of supportive interventions that are available to some of our health service colleagues.
Towards cultural change
There is a long way to go in building our work within integrated care, but we have made a start. We are currently working with five ICSs with more in discussion. As you would expect, the ways of working, points of focus and challenges are different in each and we are learning a lot about how to make it work. In each, there is a commitment to equity and to getting support to places that haven’t been well-served until now.
As with every opportunity there comes risk. Government has made a commitment to staff wellbeing, Covid recovery and addressing staff retention issues in the health and care system. The benefits of Schwartz Rounds make them an important part of this picture. But, if they are seen only as an intervention on a ‘wellbeing problem’ then there is a strong risk that they will not sustain and the opportunity for culture shift will be lost.
So, we welcome the ambition of ICSs and the opportunities for improved, integrated care for communities. And we look forward to working with many more of them to get reflective space to more of the staff that need support like never before.
[1] Maben J, Taylor C, Dawson J et al. A realist informed mixed methods evaluation of Schwartz Center Rounds® in England. Health Serv Deliv Res 2018; 6(37). ^
[2] CASCADE, Cardiff University. A randomised controlled trial of Schwartz Rounds: An intervention to reduce psychological distress for staff in children’s services. 2021. ^