Hospices and Integrated Care Systems: a balancing act

In September 2022, Hospice UK provided evidence for the UK Government's Health and Social Care Committee's inquiry. This considered how Integrated Care Systems will deliver joined up health and care services to meet the needs of local populations.

This two-part series is based on Hospice UK's submission.

Written by Annette Alcock, Head of Health and Care System Relationships, Hospice UK.

Newly established Integrated Care Systems (ICS) in England and the planned Area Integrated Partnership Boards (AIPB) in Northern Ireland remove the last official divisions of purchasing and providing healthcare in a competitive marketplace. These follow in the footsteps of the NHS Boards of Scotland and the Health Boards of Wales, by breaking down commissioning divisions and bringing together NHS and social services into one planning structure.

National governments champion regional health structures as devolved decision-making, which allow local delivery to be driven by local need. However, they run the risks of being another layer in a nationally political agenda and of a ‘postcode’ lottery of varied provision.

Palliative care requires a balance of both national policy and local, personalised care delivery. Yet across all four nations, only the Northern Irish strategy for children’s palliative and end of life care (PEoLC) remains in date. 

NHS England’s PEoLC team has followed up the requirement for palliative care in the new Health and Care Act with statutory guidance for the new Integrated Care Boards. The Welsh Government has also committed to PEoLC with a new Quality Statement and funding review. Regional boards and partnerships are responsible for how these are put into action across their areas.

In local strategies and plans there is both the need and the ability to influence the priority and design of palliative and end of life care. In response to parliamentary consultation, as in the national media, Hospice UK continues to call for good end of life care as a priority and the support of hospices as essential specialist partners.  

Hospices are well placed to promote the importance of dying well and show the benefits of adequate care provision. By engaging with the health and care planning, funding and delivery organisations, hospices will raise their profile, engender integrated working and create smooth care journeys for families. 

As a hospice, being a system leader, partner or provider should help embed their key services in local pathways and funding streams.

Hospice UK has put together useful descriptions of health and care systems as well as tips for working within them.

Our main asks of the statutory health and care system bodies are for:

1. Access to, and provision of, good palliative and end of life care to be recognised as a key policy agenda; and for this to be reflected in health and care strategies and plans as well as those specific to PEoLC;
2. Planning and delivery models for end of life care to take equal account of hospices and other non-hospital providers when considering service provision, workforce planning and data collection.

Hospices are commissioned healthcare providers, embedded community assets, and substantial fundraisers who bring money into the system. The balance of all three is a unique skill.  

If hospices are to be system partners, then there are some key requirements:

• health body contracting and funding arrangements should be simplified and aligned with others: longer term, robust risk sharing, covering agreed levels of cost, 
• hospice staff should be counted in workforce modelling and share apprenticeship and continuing professional development opportunities alongside statutory sector colleagues and, 
• population health approaches should be informed by the system-level data in Hospice UK’s PopNAT tool as well as the lived experience of families that hospices serve.

There is the danger in all big structures, and overwhelmed public services, that the hospital and acute care voice is the strongest and most urgent. Hospital trusts are key and influential leaders in boards and partnerships and are struggling more than ever with demand and backlog.  

Inequities of access and provision drive plans to bring more care into communities and to tailor services around individual need. Neither is easy to achieve, but hospices are well placed to inform and deliver both.

As with other partnerships, ICSs have a statutory responsibility to have wider membership and engagement with people, communities and the voluntary sector. This speaks to the triple role of hospices as funders, providers of healthcare and the ‘voice’ of community.