18 Suffolk and North East Essex ICS | ‘Our Journey Together’ 3.3 We shared our resources and data A system approach to managing financial resources Partners across our local health and care systems, both individually and collectively hold very significant resources and data. Health and care is a key part of local economies, with the NHS being by far the biggest budget-holder, and local authorities also managing large budgets for adult and children’s social care, public health and a range of community health services. Fragmented health and social care budgets can be a barrier to integration, but where partners deliver interdependent services, aligning budgets has the potential to improve both efficiency for services and outcomes for local people. In Suffolk and North East Essex, NHS partners worked together from an early stage to take a system approach to NHS financial planning. Working together, NHS partners not only had accountability for ensuring that their own financial control totals were met but also took a collective approach to system accountability by creating a system control total. This enabled the system to work within its budgets, attract investment funding, and ensure financial stability. The process for holding the system control total aimed to be transparent, with a clear assurance process. Developing the system control total facilitated improved relationships and trust between Finance Directors, enabling collective responsibility and partnership-based decision-making. This approach and the actions taken have delivered a range of benefits for the Suffolk and North East Essex system which remained in overall financial balance over many years, a significant achievement locally, regionally and nationally. The system approach to finance improved transparency, trust, and integrated investment planning. The ICS Board shared a high-level system finance dashboard across different NHS and non-NHS partners at monthly ICS Board meetings. Where there were opportunities to access new external investment into the system, an ICS System Investment Group brought cross-sector stakeholders together and used an outcome-based approach (see section 3.6) to provide strategic input to decisions about how best to invest new transformation funding. The potential to pool funding One of the original aims of place-based Alliances was to work towards the creation of pooled funding at place that could enable: • Shared NHS–local authority investment in services that benefit from joint approaches (e.g., discharge pathways, community care, mental health, prevention). • More coordinated planning and accountability. • Local flexibility to shape budgets around population needs. • Clearer incentives for collaborative delivery. From 2022 onwards the NHS Suffolk and North East Essex ICB devolved responsibilities for NHS commissioning to Alliances wherever possible. This action involved wider partners on Alliance committees in influencing decisions on local NHS investment. The Alliances and their local authority partners created some shared governance and leadership arrangements which resulted in joint funded initiatives across all three Alliance areas. However, the vision of genuinely pooled funding across NHS and local authorities within Alliances was never fully realised for a variety of reasons including governance complexity, provider financial pressures, and the need to achieve agreement on risk-sharing. Sharing data Bringing together NHS organisations, local authorities, and other partners ICSs offered the opportunity to link anonymised data from health, social care and lifestyle-related services to generate a fuller picture of the health and wellbeing of people and communities. Linked data can help health and care systems to: • Understand population health needs • Identify groups with similar characteristics • Spot gaps in services and plan improvements • Design more personalised and preventative care
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