You almost certainly didn't notice it, but this week saw one of the biggest shake-ups in the history of our local healthcare system. DAVID HANNANT explains what happened, why it matters and what it means for you
On Tuesday, it will be 74 years to the day since the foundation of the National Health Service.
It is unlikely that in seven decades time we will be commemorating the events of July 1, 2022, in quite the same way.
But it was a pretty significant moment in the history of the health system nonetheless.
For at the stroke of midnight on Friday, health and social care in Norfolk and Waveney became an 'integrated care system', run by a totally new organisation, NHS Norfolk and Waveney.
As so often in the health service, the language gives little hint of the importance.
Indeed, it is more likely to actively repel the man or woman on the street.
The jargon gives the public little sense of what has happened and why it matters for all of us.
So, what does this ugly, bureaucratic phrase - 'integrated care system' - actually mean and why is it being introduced?
The shake-up follows the introduction of a new law, the Health and Social Care Act 2022.
It is not limited to our region. Similar changes have been made across the country.
The ambition behind it is a big one: to make healthcare more efficient and to transform the entire approach of the system, to change the focus to 'health', as well as 'illness'.
So what is an integrated care system?
The idea is that from now on, all the organisations responsible for health and social care in our region have come together under one umbrella.
From Friday, there is a single organisation - NHS Norfolk and Waveney - responsible for pooling the resources of these areas and deciding where the most urgent needs lie.
These areas include not only hospitals, GP practices and mental health units, but also care homes and domiciliary care, local authorities, housing and the voluntary sector.
How does this differ from the current system?
Currently, the health care system is split into providers - those who run the individual parts of the system - and commissioners, who are responsible for working out how money is spent.
Until now, the Norfolk and Waveney Clinical Commissioning Group (CCG) has managed the region's NHS budget, deciding how and where this money is spent.
While health trusts have their own budgets too, they rely on the CCG to purchase most of the key things they need.
Meanwhile, the region's adult social care system is managed by Norfolk County Council and operated by private providers.
What will change?
A key change is that the CCG has ceased to exist, with its responsibilities absorbed by one part of NHS Norfolk and Waveney, called the Integrated Care Board (ICB)... if you were hoping the change might mean a reduction in jargon and acronyms you will be disappointed.
The ICB will be made up of representatives from all the separate arms of health and social care - including the region's three hospital trusts, the mental health trust, community care trusts and Norfolk and Suffolk county councils.
The board will be responsible for deciding how the NHS's £2bn Norfolk and Waveney budget is spent across the region and ensuring all parts of the system work properly.
There will also be another part of the new organisation, the integrated care partnership (ICP) - told you about the acronyms - which will determine how health and social care will be provided.
Why is this happening?
The change is being made due to a new law being introduced - which has been brought in with the aim of making health and social care run more smoothly.
Health bosses say the Covid-19 pandemic highlighted the benefits of organisations working closer together and this approach aims to build on this.
Who are the main figures?
The local integrated care board will be chaired by Patricia Hewitt, a former Labour secretary of state for health.
She served as part of Tony Blair's cabinet as health secretary between 2005 and 2007 and chaired the region's sustainability and transformation partnership - a previous scheme to join up health and social care.
Tracey Bleakley has been appointed as the chief executive officer for the ICB.
The ICP will be chaired by Conservative councillor Bill Borrett, who is currently Norfolk County Council's cabinet member for adult social services.
How does this help me?
One of the main goals of the system is to make sure people do not have to explain their situations to more than one health or care professional.
Mrs Hewitt said one way this will be achieved is through new digital 'care records', which everybody in the region will have.
"On a very practical level, the new shared care records will be a digital record that any organisation involved in the system can access and add to," she said.
"We've already seen an example of this in action with a trial that allowed paramedics in the ambulance trust to access GP records, meaning when they arrive to a callout they already know all about the patient and can deal with their needs quicker.
"The idea is so that people won't need to tell their stories several times to different organisations."
What will the system's main priorities be?
Mrs Hewitt said the shake-up will see a major change in emphasis in the way people are cared for in the region.
She said: "To me, this feels like the first time that the NHS in Norfolk and Waveney will be focussed on health, as well as illness.
"It will not just be looking at what your GPs and your hospitals can do for you - but also thinking about people's family situations, are they lonely, can they eat nourishing food, all aspects of healthy living."
Tracey Bleakley, chief executive of NHS Norfolk and Waveney, said the three main priorities were:
- Alleviating pressures on hospitals, ambulances and GPs,
- Improving mental health services,
- Ensuring people receive "the right care in the right place".
She said: "We cannot shy away from the fact people are having to wait long times for ambulances and hospital treatment and there is immense pressure on our GPs and hospitals in general.
"There are things we can do in the short term, but we have to also look at the long term."
How will the change help the region's failing mental health services?
Ms Bleakley said collaborative working would be key to helping improve the care people receive for mental health in the region.
She said: "The issues with mental health care is not simply about one organisation - it is a systemic problem that we have to address."
She said that in the past people have slipped through the net while transferring between different forms of care for mental health - which is something the new way of working needed to address.
She added: "It has to be about making sure people can access the services they need and how we can keep them from reaching a point of crisis.
"There have been times where people can only get help once they are at that point - and then they join a long waiting list for these while they are already in crisis.
"Our aim is to be able to wrap around people and give them the right treatment at the right time."
How will this help beat waiting times?
While there will be no easy solution to mounting waiting lists and pressures on the health system, the idea is that a joined-up system will reduce demands on hospitals by preventing people needed them as frequently.
Ms Bleakley said: "In the past, each different organisation has tried to protect access so the people that really need their care can get it.
"This has meant people can find it difficult to get a GP appointment or a hospital appointment. We want to make it much easier for people to get the care they need.
"If we get that right people will be able to stay healthier and be able to stay in their communities longer."
And the hope is that the more people who can be cared for in community, the fewer will need to visit hospital or rely heavily on health services - thus easing the mounting pressure.
Has this been tried before?
Not exactly. However, various efforts have been made in the past to bring health and social care closer together.
In 2013, the Coalition government pledged that joined-up health and social care would be "the norm" by 2018.
Part of this effort later saw similar arrangements set up, known as sustainability and transformation partnerships.
However, this shake-up is a far more significant change, with the two sectors, in essence, becoming one.
Will it work?
The biggest question of all. And the one we just cannot answer yet.
The challenges facing the health and care systems are familiar to every one of us.
Just as familiar are top-down initiatives emanating from Whitehall intended to make things better.
Whether this one will fare any better remains to be seen.
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