Integrated Care Systems: Shall we split the bill?

NHS Trusts and Local Government lost £2.2 billion to staff mental health absences since 2019.

From April 2022, the NHS, local authorities, and other partners are coming together to coordinate services and to plan in a way that improves population health and reduces inequality.

These ‘Integrated Care Systems’ (ICSs) aim to unify NHS Trusts with Local Government, and if done effectively, these more cohesive integrated organisations should also bring multiple workplace benefits, such as improved staff wellbeing, workforce planning, organisational performance, and cost savings.

However, with the benefits, come the challenges of aligning such huge and complex organisations. For example, the NHS and Local Government differ fundamentally in how they manage employee wellbeing and measure performance.

“For people living with multiple and long-term conditions, ICSs should deliver seamless services to those who need it most. However, the system is so large and complex that far closer collaboration between the different partners will be required to support staff, improve patient care and reduce health inequalities.”

Colm Byrne, Mental Health Nurse and former NHS Deputy Director of Workforce

Mental health is a major consideration

Since the start of 2019, employees in Local Government and the NHS have taken more than 16.4 million days off for mental health-related reasons, costing £2.2 billion.

For ICSs to improve employee wellbeing and avoid such a huge ongoing cost, they will need to take advantage of all the tools and insights available to minimise mental health issues before they burgeon into continually growing problems.

Currently, Local Government is significantly more impacted by mental health issues than the NHS

FirstCare’s ICS Preparation Alert reveals that 25 percent of all lost working time in Local Government (from 1 January 2019 to 31 August 2021) was due to mental health-related absences compared to 18 percent in the NHS.

Mental health is now the top reason Local Government employees take time off work

• Mental health troubles have been the Local Government sector’s top reason for working time lost in 24 of the last 32 months, equating to 8.44 million working days lost.
  
• The average duration of mental health-related absence is 37% lower in Local Government than it is in the NHS (21.75 days vs. 34.57 days respectively).
• Local Government has seen 68% more spells of mental health-related absence than the NHS since 2019 (around 388,000 vs. 231,000 respectively). Mental health issues account for eight percent of all spells of absence in Local Government compared to five percent in the NHS.

Mental health in NHS Trusts

• During the pandemic, the NHS has lost most working time to non-medical reasons for staff absence, such as Covid self-isolation, care of a dependent, Test & Trace notifications, etc.
  
• Mental health issues account for only five percent of all spells of absence, but due to their average duration (34.57 days) they account for 18 percent of all lost working time.
  
• Time off for poor mental health lasts on average three times longer than for Covid-related absences (around 34 days, compared to 11 days respectively).

“The formation of ICSs is one of the biggest changes in health and social care in over 50 years. The vision is admirable, yet the practicalities of this unprecedented union need to be fully understood. NHS Trusts and Local Government are fundamentally different in many essential ways, including operational structures, performance metrics and the way staff are managed. To overcome serious challenges, including mental health and Covid, ICSs need to establish a joined-up way to ensure both their organisations and critically, their people are in good shape.”

Alun Baker, CEO of FirstCare

The £2.2 billion combination that needs to be tackled

From January – August 2021, the direct cost of lost working time due to mental health-related absences in Local Government totaled an estimated £316 million; for NHS Trusts it was £243 million.

The combined direct cost of mental health-related absences across both sectors was £704 million in 2019, £897 million in 2020, and £559 million in 2021, totaling £2.2 billion since 2019.

It’s clear that such important issues need to be prioritised, and ICSs will need a joined-up, data-led approach in order to be successful.

Many NHS Trusts and local authorities have already begun to make significant improvements by utilising real-time data to create a clearer picture of staff health and wellbeing. 

This week, FirstCare will join hundreds of senior leaders from the public sector meeting at the Health Service Journal Integrated Care Summit in Manchester to discuss the introduction of ICSs and the future of health and social care.