15 July - Mental Health Network - Governance during the COVID-19 pandemic

This week's meeting was joined by Matthew Taylor, CEO of the NHS Confederation, to share insights and reflections from his first six weeks in his new role.

On systems, he shared that at the heart of the ICS agenda are many ideas and principles which leaders agree and have called for – including integration, building services around communities, moving to a population health model, reducing health inequalities and the need to do this to live up to the principles of the NHS. Matthew reflected on the importance of mental health being recognised with parity of esteem and tackling the social determinants of health, and confirmed that the Confed is calling for parity of esteem and effective representation in the governance structures.

Matthew also shared that there are risks around a new secretary of state and chief executive fully owning the integration agenda as they did not design or lead the initial stages. There are also serious funding difficulties and you would normally want more funding available to support significant change, as well as this being alongside increased pressure and no scope yet of the money that will be available for the rest of the year.

He reflected that he feels the principles behind ICSs are right and these approaches make a difference to people, and we risk losing this if we abandon the legislation when difficulties inevitably arise. This should instead be an opportunity to learn, build and develop systems further to support the underlying principles to work in practice. He is therefore looking for concrete examples of how applying these principles can make a difference, even if the structures aren’t perfect or fully defined yet.

There was a discussion around local freedom, control and flexibility and broad agreement that the new systems won’t work if there is significant interference at local levels.

Matthew shared that there needs to be a story about what we’re trying to achieve, beyond the network how are taking advantage of the fact that the network sits alongside others. On the Confed, he feels it has improved in bringing the different parts of the system together and effectively representing all parts. He shared his priorities are:

• improvement, especially how we can be a force for improvement via peer to peer working

• innovation – if we don’t innovate we won’t close the gap between demand and resources

• ideas – encouraging the Confed to balance agenda setting and responding to the here and now

The NHS and public services have inherent problems and challenges, and ICS’s need to push through them, to tackle and mitigate them, and they won’t be meaningful unless they do. Some of the biggest difficulties within the NHS includes:

• Misallocation of resources – the people in the most need don’t get the resources, and more empowerment of patients can increase this.

• Organisations will naturally organize things in ways that suit them not around patients.

• All organisations have tendency to address what’s in front of their face rather than go upstream and address prevention.

• Different levels of performance and not wanting to talk about – but the role of the ICSs need to ensure the worst is catching up with the best.

The questions will be what are the fundamental problem that organisations tend to have and how can ICSs help address that? Whilst also acknowledging the different geographical structures in play.