Daily Insight: Integrated chaos system

A hospital chair’s candid assessment of how her ICS planned to arrange itself –  that some of the newly created tiers “seemed absolutely daft” and “a backward step” – has received a perhaps unsurprising sympathetic response from HSJ readers. 

Anna Davidson, chair of James Paget University Hospital FT, who sits on Norfolk and Waveney’s ICS interim board, gave her damning assessment of the proposals at a board meeting this week.

Ms Davidson was also given a sympathetic response from the ICS’s chair Patricia Hewitt, who made it clear the proposals were “work in progress” and nothing was set in stone yet. 

And the acute chair was not the only one to express such concerns. Another board member, Beccy Hopfensperger, a Suffolk County Council councillor, said the newly planned local alliances and partnerships could “end up going in two separate directions”.

The laudable aim of ICSs is of course to drive collaboration and better integrate health and care. But, of course, when a plan collides with the real world, it’s rarely that simple.

There is clearly much to do in Norfolk and Waveney, which is one of the five ICSs placed in the recovery support programme last July. While Norfolk and Waveney is one of the less mature ICSs, similar conversations are happening all over England as NHS leaders wrestle with this latest reorganisation. 

Private spend made public

NHS commissioners’ spending on private healthcare rose faster than spend on NHS trusts and general practice, due to the pandemic.

The outlay increased 27 per cent to more than £18bn in 2020-21, a year-on-year growth in cash terms of £3.9bn NHS England’s annual accounts have shown.

They indicate that spending by NHS England and clinical commissioning groups (which together fund all NHS care) with NHS trusts and foundation trusts was up 20 per cent in cash terms in 2020-21, compared to the previous year. Spending on general practice was up 14 per cent.

In absolute terms, the amount spent with NHS providers remains several times higher than that in the private sector.

As the pandemic hit the UK in earnest in March 2020, the NHS nationally signed major contracts with independent sector providers to reserve their capacity, both for a potential huge surge of covid patients, and for elective care which NHS hospitals were having to cancel.