Context, integration and outcomes
A crucial insight from the ICE platform has been illustrating the link between an ICS’ average deprivation (IMD) score and the platform’s integration score index, which can be used to identify health inequalities — as illustrated in this interactive map that combines the IMD score and CF’s calculated integration score for each ICS across the country.
Conducted by CF, the research has shown that systems with higher levels of deprivation generally have less integrated health services. That said, there are examples of higher and lower levels of service integration at every level of deprivation. The findings provide critical insight for policymakers and ICS leaders looking to set strategy.
Equally, the index shows that ICSs with low levels of deprivation perform well across integration measures. For example, Hertfordshire and West Essex perform well for indicators across all three chasms. In particular, there is a high level of integration between community-based and hospital-based care — showing that, on average, residents can expect shorter stays in hospital and are less likely to be admitted to hospital in the first place.
The analysis does not suggest that deprivation is specifically responsible for poorer integration, and there is a complex relationship between healthcare outcomes and deprivation, beyond the integration of services. It is well understood that higher levels of deprivation often result in poorer outcomes. However, the relationship between deprivation and integration should not be overlooked and can help ICS leads to focus on those areas that will have the biggest impact on resident health.
It is critical that ICSs and places within them are armed with data to help them understand their starting point, set aspirations and develop their strategies. This analysis implies IMD critically influences the complexity of integrating services, but equally, it shows that there is such variation amongst integration between ICSs with similar deprivation levels that context need not be destiny. Ultimately, this suggests that each ICS and place across England should seek to identify where and how it can integrate better for its population, incorporating context when thinking about what they want to achieve.
Further detail on this topic and be found in our Insights section.