As you’re pumping flood water out of your house, you’ve decided to reconfigure the rooms, knock some walls down, shift the windows and doors…but first things first, as we were taught as children. 

 

Yet, that is the situation we find ourselves in with the proposed implementation of integrated care systems (ICSs). It’s not exactly the same as struggling with a deluge to your home and embarking on a rebuilding programme, but it’s not far off.

 

We are still battling with the greatest healthcare crisis in our lifetimes. People continue to become infected with COVID-19, some are admitted to hospital, sadly a number will die. The vaccine rollout proceeds at pace, but uncertainty remains over the rollout of the booster injections – when will that programme begin? Who will administer the jabs? We’re in the middle of the school and university holidays, but soon, pupils and students must return, with all the trepidation that brings. And I haven’t even mentioned the yet-to-be-understood effects of long-COVID and the huge backlog of postponed procedures. Oh, and did someone say that all those caught up in fighting the pandemic are exhausted and would welcome a well-earned breather?

 

But apparently, we’re to press ahead with the new ICSs. Surely, it makes sense to pause, to delay their introduction for at least another two years? The last topic anyone wants to contemplate right now is major upheaval. 

 

I’ve not yet mentioned, too, that we have a new health secretary and a new NHS England chief. Sajid Javid has had little respite in which to familiarise himself with the landscape, let alone altering it; his executive supremo will have even less than that. 

 

Experience also suggests we should put the ICSs on hold. Recent history of structural reform has not been a good one. So-called “improvements” have been anything but, tending to over-promise and under-deliver. 

 

We’re also doing this against a backdrop of numerous inquiries into the health system’s response to the virus. It would be ridiculous if at the end of those reviews, a different framework was deemed more suitable. Hesitating, taking stock to get the changes completely right, makes for perfect common sense – to rush ahead smacks of madness and, dare I say, fiddling, wanting to impose a new management formula, just for the sake of it. The King's Fund has raised a caution that these proposals come at a time when the healthcare sector is still busy battling COVID-19 and must not be distracted. Community pharmacy, one of the sectors most directly affected by the shake-up, should shout for the same.

 

Integrated care is intended to improve people’s outcomes and experiences by bringing health services closer together. ICSs are about shaping the health services specifically for the community they serve, ensuring patients achieve the best possible outcomes. It’s vital, therefore, that the ICSs listen fully to the people who will be in the firing line of their decisions. For the developments to work properly requires a cultural shift, for managers to become more action-centred – not only capturing the views and voices of the people they will affect, but acting upon them.

 

The case for pharmacy is obvious. We are accessible, trusted and located in the heart of the very communities all ICSs aim to reach. Pharmacies defy the inverse square law when it comes to health, existing prominently in areas of greatest need and deprivation. We’re located on pretty much every high street, making our services hugely convenient for most patients, which means they are more likely to use them. That would suggest, therefore, that the prospects for a successful rollout are more achievable with pharmacy playing a pivotal role. 

 

Not only must ICSs listen, but they should respond. ICS boards must break down traditional management silos and narrowmindedness, to utilise resources more effectively. ICSs must ensure that services are brought nearer to their people – and that means utilising every single pharmacy at their disposal, and in a positive, more clinical way.

 

We want ICSs to involve everyone, not just listen to those who speak the loudest. Do stakeholders really understand what is working and what isn't? Do they know what people in communities are thinking? Why not treat all the professions in the area equally and give them a place on the board? These are the sorts of questions that need to be addressed if we are to truly revolutionise healthcare and make ICSs secure a better future. 

 

It can be done, but it will take longer. This is so not the time to be embarking on a headlong transformation.