The government clearly expects that ICSs will play a critical role in the reform of adult social care, setting out a 10-year vision to transform care and support and the investment of £5.4 billion over the next three years to improve social care in England.

The Integration White Paper focuses on structures, frameworks and organisations, and making the NHS and Local Authorities’ work better, together with the “Place“ level being the focus of integration  However, the ICS implementation guidance is largely permissive and there is a real danger that social care providers will not be recognised as crucial strategic delivery partners and we will not see the culture change needed to build a partnership of equals which enables better population health and wellbeing outcomes.

Social care providers matter to ICSs as they are a critical part of the health and care system, providing vital services. They need to have their voice heard at the top table of ICS decision making and planning as they are key to helping deliver population health and care outcomes. Millions of people across the country draw on care and support from social care providers and they employ the majority of the overall social care workforce which currently sits at 1.54m according to Skills for Care’s annual workforce report.

The Local Authority voice is only one aspect of social care in an ICS. Social care providers bring valuable expertise in their own right; it is important to remember that Local Authority data and knowledge alone cannot equip the ICS planning processes with a comprehensive view of the social care offer. A significant section of the sector is not funded via LA commissioning.

The adult social care white paper, People at the Heart of Care, emphasises the importance of shaping healthy and diverse social care markets. It acknowledges that currently there is not sufficient encouragement for new, innovative, community-based organisations that have the potential to give people greater choice, independence and wellbeing. Social care providers, especially not for profit providers, are deeply rooted in their local communities and can assist ICSs to have a more direct and ongoing dialogue with communities and people. They bring hugely valuable expertise in meeting current and future needs of their wider communities, including those who fund their own care and rarely have contact with their LA.

So, what can social care providers do for ICSs?

Responsive service design and new models of care: Social care providers are highly experienced at delivering agile solutions which can make a significant contribution to planning for better joined-up care. They can bring to the table long standing experience in mobilising assets and delivering services around the needs of people who use services, carers and communities, within constrained budgets. Care pathway planning will also be enhanced by understanding and capitalising on the types and range of housing solutions delivered by social care providers and their responsiveness in adjusting to changing needs.

The adult social care white paper includes £100m funding for innovation – of this more than £70m is designed to increase the support for innovation across adult social care and £30m is being provided to help local areas innovate around the support and care they provide. The collective response to the Covid-19 pandemic has demonstrated how innovation can address longstanding issues, and how integration can work well when funding is invested and budgets are pulled together.

Joint ICS health & care workforce planning: the crisis in the health and social care workforce can only be addressed if the recruitment, development and retention of staff is approached in a joined-up way, with meaningful collaboration with social care providers as operational and strategic partners. This is absolutely essential to ensure the ability to respond to new requests for care, maintain the existing provision of care and support and work together in one system to respond to the increasingly complex needs of the local population.

Harnessing the power of technology & intelligence in better planning and delivery: Supporting the digitisation of the sector will enhance quality and joined up delivery of care and support. Improved collection and sharing of data and intelligence will inform effective planning, assist with measuring system outcomes and provide evidence for CQC assessment requirements. We must harness learning between sectors as well as establishing meaningful digital and data strategies to inform system-wide workforce planning. Innovation and the insights drawn from data will also lead to new models of care and enhance understanding of population health issues including unmet need and disparities. The timescales to achieve this as outlined in the white paper are very ambitious and it is essential that social care providers are included in the process of ICSs finalising their Digital Investment Plans by June 2022.

ICSs can engage with social care providers in a number of ways. To ensure a robust social care voice within the ICS architecture we recommend a social care non-executive director (NED) on the Integrated Care Board who would bring expertise when planning and commissioning services and allocating funds to deliver the Integrated Care Strategy. This NED should also have a role in championing and overseeing the social care provider voice across the decision-making forums in each of the ICS tiers. They would support the board in developing metrics that report on the aspects of the CQC assessment framework which relate to social care and integration.       

Social care providers must be embedded in decision-making forums at place and neighbourhood level because it is at these tiers that the real operational change will be led.  Guidance emphasises the importance of subsidiarity with local partners developing local plans to meet local needs. Without a robust partnership with social care providers this will be like making a jigsaw with half the pieces missing.