Today’s report from The King’s Fund, Integrated Care Systems in London: challenges and opportunities ahead1, finds that health and care organisations across London have worked together more closely than ever before to improve and join up services in response to the covid-19 pandemic.
The new report, commissioned by London’s Mayor, looked at how London’s five integrated care systems (ICSs) – set up to enable joint working between the NHS, local authorities and community organisations – had been working before and during the first wave of the pandemic2. It found that Covid-19 created a clear common purpose that allowed health and care organisations to work together to shift how their services were delivered. In some cases, changes that would normally have taken years to achieve happened in the space of weeks or even days. The report highlights rapid changes enabled by this greater collaboration including:
- massive leaps in remote access with many Londoners able to access virtual outpatient appointments and speak to their GP on the phone or by video
- faster problem solving across organisations through frequent contact – meeting daily at some points in the pandemic – to find solutions such as sharing limited PPE supplies
- closer work with voluntary and community organisations and local pharmacies to support people who were shielding
- changes to services such as the creation of ‘hot’ and ‘cold’ hubs to separate patients with suspected covid-19 from non-covid patients. This helped to keep Londoners as safe as possible while still delivering key services
The report found that the temporary suspension of some national rules such as those around funding discharges enabled more integrated provision of care.
However, the report also highlights the stark health inequalities that existed in the capital prior to the pandemic with life expectancy varying between boroughs by as much as 15 years for women and 19 years for men3, and that covid-19 has exacerbated these health inequalities further among Londoners, including those from Black, Asian and minority ethnic communities, homeless people and people with learning disabilities.
The report found that there is now strong commitment among London’s health and care leaders to pursue the reduction of health inequalities with greater vigour. The report’s authors propose that ICSs must now ‘seize the moment’ by strengthening collective action on health inequalities and play a key role in moving from aspiration to action on reducing health inequalities across the capital. The report recommends sustained collaboration at three levels:
- Locally led action on health inequalities should be co-ordinated by London Borough based partnerships
- Integrated Care Systems will play a crucial role in linking the work of the boroughs with London-wide initiatives and public health expertise
- At a London level, partners need to revisit which areas will benefit most from a coordinated response across the capital and update them in light of the impact of the pandemic. For example, around health inequalities and the likely rise in demand for mental health services
The report adds that, before service changes brought about by the pandemic can be made permanent, there needs to be adequate scrutiny, including public consultation and engagement.
Richard Murray, Chief Executive of The King’s Fund and one of the report’s authors said:
“One of the few silver linings from the pandemic was the big leap forward in joint working to deliver health and care across London. This allowed London’s health and care services to respond to the unprecedented challenges of covid-19. However, covid-19 also laid bare the deep health inequalities that blight the lives of many Londoners. London’s health and care leaders now need to use this momentum and sense of common purpose as a catalyst for tackling inequalities and addressing London’s health challenges.”
The Mayor of London, Sadiq Khan, said:
“It has been an extremely challenging year for our NHS and social care services as staff have gone above and beyond to help and care for Londoners. Covid-19 has devastated our city, but this report highlights how health and care organisations have worked together in the face of such difficult circumstances, and have importantly united to tackle health inequalities. The virus has had a disproportionate impact and widened the already unacceptable health inequalities in our capital, and I will continue to champion, challenge and collaborate with the NHS to ensure a fair and healthy recovery for all Londoners.”