(Participant 3, Focus Group 1 (FG1))Ĭoncerns were raised that competing organisational priorities and limited resources could hinder collaboration when COVID-19 becomes less of a shared priority. The relationship with social care’s improved, ‘cause we all felt so awful about what’s going on there, so there’s a kind of emotional attachment to that. The beginning was very much dominated by the acute trusts…slowly I think the dialogue between different partners, including public health, has become a little bit more balanced. Participants reported that while the response initially focused on the acute sector, the community perspective became more vocal, with better integration of social care and guidance from public health teams. The priority of COVID took people away from their organisation’s culture and they had a similar driver. Participants agreed that uniting on the pandemic response improved organisational collaboration, with increased networking between individuals and organisations to combat problems and greater understanding of challenges faced by other organisations.
This research aimed to evaluate the COVID-19 response at an ICS level (including structures, processes and outcomes) and use this learning to inform ICS development.īuilding organisational and sector collaboration 12 An in-depth exploration of ICS partnership working was therefore warranted. 11 Health, societal, and economic outcomes of COVID-19 have been influenced by decisions taken at organisational, local, and national levels. National reports examining COVID-19 conclude profound numbers of excess deaths and inequalities in morbidity and mortality rates, with poorer outcomes for disabled people, care home residents, and ethnically diverse and socioeconomically deprived communities. Escalation procedures were followed as appropriate (eg, Silver (tactical) escalated issues requiring system-level approvals and decision-making to Gold (strategic) command). Gold (including Chief Executives) and Silver (including Chief Operating Officers) each met separately regarding their responsibilities on a regular basis. 10 Gold and Silver command included senior professionals in the acute trusts, CCGs and local authorities (social care and public health), and were pertinent in leading the system response evaluated in this study. ‘Gold’ command (responsible for strategic direction of the multiagency response), ‘Silver’ command (responsible for tactical planning and coordination of the response) and ‘Bronze’ command (responsible for operational management of the response) brought together key partners. 8 9 A Gold–Silver–Bronze hierarchy of working was implemented, with bidirectional communication between command levels to plan and respond to issues. To reduce COVID-19 infections and support health and social care, incident command structures were activated.
5 Cross-organisational working is built upon pre-existing structures, notably sustainability and transformation partnerships, 6 7 with partnership working particularly demanded during COVID-19. While ICSs share broad goals, there is no single blueprint model for an ICS given structures can be modified to meet local needs. 3 The National Health Service (NHS) Long Term Plan aimed to establish ICSs across England by April 2021, with a total of 42 ICSs established.
2 Integrated Care Systems (ICSs) are partnerships between health and social care providers, clinical commissioning groups (CCGs), local authorities, and voluntary organisations to improve population health, reduce health inequalities, and ensure integrated and coordinated health and social care services. 1 Recent changes to policy and legislation intend to better integrate health and social care services in England. Effective health and social care systems must support the needs of a growing population and recognise the increasing complexities of people living with multiple long-term health conditions.