27 Suffolk and North East Essex ICS | ‘Our Journey Together’ 4. Our Challenges Stakeholders consistently raised two key challenges in particular that they felt had undermined the potential impact of the Suffolk and North East Essex ICS over the last decade: • non-coterminous geographic boundaries • demographic and socio-economic trends 4.1 Non-coterminous geographic boundaries Alignment of NHS and local authority boundaries is a particular challenge in the East of England which has some local populations who will regularly cross county boundaries not only to access NHS services but also to shop, access employment, education or worship, because that makes most local sense to them. The geographical footprints chosen in 2016 for the six STPs in the East of England presented consistent complex challenges for several key partners, in particular Upper Tier Local Authorities (UTLAs), and it could be argued that they favoured NHS organisations. The geographic footprint for Suffolk and North East Essex included Ipswich and East Suffolk, West Suffolk but not the Waveney area of Suffolk – and North East Essex, but not the rest of Essex which instead related to two other ICSs (see diagram opposite). Many stakeholders talked about the consequences of this lack of coterminosity which they thought had introduced elements of resistance and frustration into the ICS, particularly for some key partners. This undoubtedly contributed to slower progress with integration than might have otherwise been the case. Some stakeholders also felt that it had also created an air of ambiguity about whether they were indeed full partners in the ICS and a sense that the ICS was essentially an NHS initiative in which they were only a peripheral party. It was the consistent view of the County Councils that ICS county alignment would enable better integration and alignment for purposes of improving population health and addressing the wider determinants of health and wellbeing. The issue of coterminosity also impacted other county-based organisations e.g. Healthwatch, Local Medical Committees, and Community Foundations. For those that needed to relate to more than one ICS this could put pressure on capacity particularly in small organisations. For the NHS, the Suffolk and North East Essex ICS boundary did support one particular key aim at the time which was the merger in 2018 of the former Colchester and Ipswich Hospital Trusts to form East Suffolk and North Essex NHS Foundation Trust (ESNEFT). However ICS geographic boundaries were experienced by other NHS providers in different ways. For example, both specialist mental health NHS Trusts (Norfolk & Suffolk NHS Foundation Trust and Essex Partnership University NHS Foundation Trust) and the East of England Ambulance Service NHS Trust served multiple ICS areas and which they felt at times affected their ability to contribute meaningfully. This issue was possibly compounded for some organisations focusing on internal quality issues during this period. Other organisations who served only to specific local places e.g. West Suffolk NHS Foundation Trust, often prioritised local place-based projects over system wide activities. Picture – Regional Map showing ICS and UTLA boundaries, 2016-2026
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