Integrated Care Strategy 2023-2027

The Nottingham and Nottinghamshire Integrated Care System (ICS) brings together partner organisations from across health and care with a renewed focus on providing joined up services and improving the  lives of all people who live and work in the city and county.

Our five-year strategy was developed following extensive engagement and first published in 2023. We have refreshed the strategy on an annual basis and this year we continue this approach. This ‘light touch’ refresh identifies the priorities that we need to amplify in 2025/26 to deliver our agreed ambitions to improve health and wellbeing outcomes for the people of Nottingham and Nottinghamshire. Although not an extensive rewrite, we are clear in this refresh of our continued commitment to support delivery of our strategic aims:

• improving outcomes in population health and healthcare
• tackling inequalities in outcomes, experiences and access
• enhancing productivity and value for money, and
• supporting broader social and economic development.

This refresh is also written within a highly dynamic national and local environment. This will require us to have ongoing consideration of a number of evolving issues as we continue to deliver our strategy over 2025/26.  These issues include:

• Ongoing system challenges in respect to quality and safety concerns alongside rising demand for services
• Local Government Reform agenda and the changing landscape of local authority responsibilities across Nottingham  and Nottinghamshire.
• The ongoing maturity of our East Midlands Combined County Authority (EMCCA) and its emergent  programme of work to support the economic  regeneration of both the Derby and Derbyshire  and Nottingham and Nottinghamshire communities.
• Implementation of the recently published NHS 2025/26 priorities and operational planning guidance (January 2025) and our desire for NHS organisations to improve access to, and performance of, services.
• Maintaining our absolute commitment as accountable public sector or voluntary and community sector organisations to deliver services to people within our financial means. All partners are experiencing challenging financial positions and working hard to drive greater efficiency and productivity.
• We are eager to match the commitment of central government to pursue the three shifts from treatment to prevention, analogue to digital, hospital to home. These shifts are highly compatible with our existing strategic approach and principles of Prevention, Equity and Integration. This gives us renewed confidence that by continuing to work in partnership, working with and alongside our communities, we will achieve improved outcomes for local people.
• As a system we continue to actively engage in the development of the NHS 10 Year Plan, due for publication in late Spring. This is likely to require us to undertake a more extensive review of our Integrated Care Strategy in 2026/27.  Planning for this has already started.

This document will outline the three things we will jointly focus on in 2025/26 to further advance the achievement of our strategic aims.  These are:

• Promoting work and employment.
• Supporting children and young people.
• Supporting frail and vulnerable people.

We believe these priorities, along with our ongoing commitments, will best serve the interests of our communities. In their pursuit we will also remain true to our strategic principles of promoting prevention, ensuring equity and delivering improvements through greater integration.

Dr Kathy McLean OBE Chair of the Integrated Care Partnership
Chair, NHS Nottingham and Nottinghamshire

Cllr Jay Hayes
Vice Chair of the Integrated Care Partnership
Chair of Nottingham City Health and Wellbeing Board

Cllr Bethan Eddy
Vice Chair of the Integrated Care Partnership
Chair of Nottinghamshire Health and Wellbeing Board

The Integrated Care Strategy is implemented through both Joint Health and Wellbeing Strategies and the NHS Joint Forward Plan. In developing our light touch refresh we have listened to local partners and staff to confirm that our strategic principles of prevention, equity and integration remain valid, and to identify areas were coming together at a system level will add value. We have duly considered local Joint Strategic Needs Assessments and other data and analysis to understand where greater opportunity lies to achieve our strategic aims. We have also considered national policy requirements and our statutory obligations. We are not achieving the sustainable improvements we would wish to. Therefore, we need a step change in our collective efforts in 2025/26 in those areas we know will make a significant difference:

• Promotion of good work and employment which significantly contributes to overall mental and physical health as well as broader social and economic regeneration
• Support for children and young people to have the best possible health outcomes, recognising that our children are 20% of our population but 100% of our future
• Improving our offer of support to people living with frailty or complex needs, recognising this offers opportunity to improve outcomes and promote cost effective use of resources.

We will also ensure a continued roll out of Making Every Contact Count across our wider partnership.

This refresh also signals our intent to be truly transformational in the way our system operates – enabling us to secure long lasting sustainability to the services we offer local people within our collective resources. In 2025/26, whilst focussing on our priority areas, our overall transformation will be characterised by:

Accelerating our integration of health and care teams at neighbourhood level

• Multidisciplinary teams of health and care professionals will be created at pace in 2025/26 to create a ‘one team’ approach to meet the needs of a defined population cohort. At this early stage this will be people identified as moderately or severely frail or living with complex needs (including children and young people).
• Over the next five years teams will mature to incorporate all age, physical and mental health needs of a defined population supporting people to remain independent for longer within their own homes.
• There will be a system model for consistency of approach and impact, but its implementation will be sensitive to the specific population needs of each neighbourhood based on population health data and local intelligence.
• This will enable us to target resources better and ensure local interventions are evidence informed and codesigned to be culturally sensitive.
• Place based partnerships will continue to focus on the building blocks of health such as employment, housing, education, encouraging healthy eating and movement, smoking cessation, addressing alcohol misuse etc. They will support neighbourhoods within their footprint to flourish and be active in encouraging local health and care interventions that meet the needs of specific communities.
• Our wider partnership engagement at place level is well established and benefits greatly from the ongoing invaluable support of our local authorities, voluntary and community sector as well as NHS bodies. We wish to encourage this ongoing collaboration in 2025/26 and beyond. Integrated Neighbourhood Teams (INTs) will therefore be a significant building block as part of a wider longer-term ambition to create thriving communities across our system.

Aims for Integrated Neighbourhood Health Teams over the next five years:

• NHS and social care working together to prevent people spending unnecessary time in hospital or care homes.
• Strengthening primary and community-based care to enable more people to be supported closer to home.
• Connecting people accessing health and care to wider public services and third sector support, including social care, public health and other local government services.

Promoting greater provider collaboration at place and system level

• We will encourage providers of health and care services to work together more collaboratively and develop more efficient ways to provide services to people. This will reduce duplication, waste and inefficiency across our system. Providers will increasingly share resources, infrastructure, estates, and staff to achieve this.
• We will support hospital providers to continue to work together. This will especially be welcomed in relation to services that are regarded as fragile so that we can promote resilience of services for our population. This will include working more closely with providers in other regions where this makes sense.
• System partners will continue to deliver key transformation programmes using best practice programme methodology to ensure robust oversight and delivery of intended benefits. These programmes will accelerate delivery of the ‘three shifts’ of treatment to prevention, analogue to digital, hospital to home in 2025/26.
• Continue to develop our Voluntary, Community and Social Enterprise Alliance to engage and embed the sector within system governance and decision-making structures.

Accelerating collaborative commissioning approaches and creating the conditions for success

• Our commissioning organisations, Nottingham City Council, Nottinghamshire County Council and the ICB, will work closer together to develop strategic approaches to developing pathways and services, combine our skills and make best use of our collective resources.
•  We have previously committed to developing new ways of re-prioritising resources so that people who need our support the most receive it. In this coming year we want to make a step change to implementing this approach.
• We will work with organisations and partners both within and outside of our local area to make sure that we’re getting the best outcomes for our local people within the resources we have. This includes working with our East Midlands Combined County Authority on their health and care priorities as well as working with partners across our region.
• We’ll learn from other areas and work with our universities, our clinical leaders and health and care staff to make the most of the money that we have through a more cohesive approach to strategic commissioning informed by evidence, data and intelligence.
• In 2025/26 we will continue to work collaboratively as system partners to make difficult decisions about how and where resources are to be best deployed to achieve our ambitions. This will also include exploration of new ways to commission local service delivery and outcomes. It will also include exploring new mechanisms within which shared commissioning and service developments can be jointly discussed.

As a joint strategy across NHS and local authority partners it remains important that our focus on the promotion of wellness and prevention of ill health does not diminish. Work will continue into 2025/26 to more clearly refine our prevention delivery priorities with our Health and Wellbeing Boards and in light of ongoing discussions with EMCCA. There is however already a high level of agreement that we collectively continue to pursue prevention initiatives related to:

• Making Every Contact Count – roll out MECC training and support the front-line staff across our partnership have healthy conversations. These conversations promote a ‘no wrong door’ concept, they connect people to key services, and they provide an opportunity for front-line staff to play an active role in our prevention priorities (see below).
• Health and Work – support our staff to promote the benefits of accessing work and/or staying in employment to their patients and service users, especially in areas of highest deprivation and need. A range of initiatives are already provided across our system. In 2025/26 we will seek to map these and identify further opportunities where we can add further value.
• Best Start through the development and delivery of our refreshed Best Start Strategies across Nottingham City and Nottinghamshire County. We will focus on keeping children and young people well and healthy by ensuring the building blocks of wellbeing are in place for all children, including a safe and warm home, close and supportive relationships and attachments in early life and beyond and access to a good education. We will also continue to work together across partners to build our approach to the Keeping Children Safe Helping Families Thrive policy statement and associated transformation.
• Reducing alcohol misuse through targeted interventions.
• Promoting exercise and movement – which alongside healthy eating and reducing obesity can make dramatic differences in overall healthy life expectancy at any age. Exercise in later life, promoting muscle strength and coordination in older people can be especially important to avoid falls and deterioration of independence.
• Promoting vaccinations and immunisations especially for older and more vulnerable adults and children and young people.
• Effective management of long-term conditions such as cardiovascular, respiratory disease, dementia, diabetes and cancer and tackling social isolation and loneliness.
• Continuing to support people with severe multiple disadvantage and those living more  complex lives in order to improve overall life chances as well as health outcomes.

Underlying this agenda will be ongoing work to address health inequalities and equity through the Core20PLUS5 work already established across our place based partnerships and delivered through NHS and local authority partnerships.

Monitoring of progress

Whilst we have made progress in delivering improvements for our local population (see case study examples below), there remain areas of ongoing significant challenge. Oversight of the delivery of the Strategy will continue to be the responsibility of the Integrated Care Partnership with delivery of in-year activity and outcomes monitored on a routine basis via the Integrated Care Strategy Operational Outcomes Group.

Through our continued focus on the priorities identified for 2025/26 and driving our transformation agenda for sustainability through increased integration we will achieve the following outcomes:

Overall Integrated Care Strategy Ambitions:

• Improve people’s life expectancy
• More people live healthier longer lives
• Reduce health inequality across our population

What we can expect from our work together in 2025/26 that will continue to contribute to these aims:

• For People: Proactive, anticipatory care and maintaining our focus on preventing poor health and wellbeing will help reduce deterioration of people’s health and reduce their reliance on more expensive hospital care.
• For Our Communities: Increased collaboration across our providers and supporting our Place based Partnerships will improve access for local people to services that meet their needs within their communities and closer to home.
• For Our Teams: Staff working more flexibility across provider arrangements will be empowered to provide locally sensitive care and feel part of a wider collaborative and more unified health and care team.
• For Our System: Reduction in inefficiency, waste and duplication and more targeted use of resources to achieve impact will improve cost-effective use of our combined resources.  This will contribute to financial sustainability and resilience across our system.

In October we held our annual Nottingham and Nottinghamshire Health and Care Awards to celebrate our successes. A selection of case studies are included with more details on all of our winners.

Case Study Broxtowe Learning Disability Collaborative

Broxtowe Learning Disability Collaborative designed and implemented a series of Learning Disability Health and Wellbeing Roadshows aimed at improving the outcomes and experiences of people with learning disabilities.

The roadshows provided a safe space for people with learning disabilities to have their voices heard and to share their experiences about what matters to them. They also encouraged uptake of the annual learning disability review, raised awareness of the wider determinants of health and promoted a holistic approach to health and wellbeing.

As a result, a number of actions have been implemented including training experience for every PCN trainee nursing associate, Oliver McGowan training with leisure staff, setting up sensory flu clinics for people with learning disabilities and creation of a learning disability advise and information repository.

Broxtowe Learning Disability Collaborative video

Case Study MEN AT THE EDGE, Oasis Community Church

The MEN AT THE EDGE Project started four years ago following fundraising and time spent restoring property and portacabins at the EDGE site on Plantation Hill in Worksop. The project started in response to a high suicide rate for the area and evidence showed that men were experiencing issues with mental health, unemployment, physical health and disability and isolation.

The team restored a derelict site and began a project to create a safe space for men in any kind of need. Sessions ran several mornings each week with another special morning for veterans, social evenings, men’s breakfast project, lifeline educational projects.

The EDGE is a place of safety, security, solace and support and the number of men accessing it has been growing week by week. The EDGE offers support before, during and after other interventions. People need the service to find a place they can belong and find ongoing care and support from people who care for the long term.

MEN AT THE EDGE video

Case Study Lung health checks for people with severe multiple disadvantage

Targeted Lung Health Checks (TLHC) help to identify lung cancer at an early stage when there are more curative treatment options available. Prior to the lung health checks, less than 25% of lung cancers were diagnosed at an early stage. As part of a new innovative approach to reduce health inequalities, the TLHC team have worked collaboratively with system partners to deliver these lifesaving checks to some of the most disadvantaged groups in Nottingham.

Nottingham has the eighth highest prevalence of severe multiple disadvantage (SMD) in England and people experiencing SMD have poorer health outcomes than the general population. The lung health check service offered dedicated walk-in clinics, and the service was adapted to make it easier for people experiencing SMD to attend. There were 15 people identified as eligible and 13 attended during the time ringfenced for drop-in clinics, including three opportunistic drop-in patients too. All 13 patients were assessed as high risk, supporting evidence that this group is at higher risk of developing lung cancer.

Two patients were fast tracked into NUH with suspected lung cancer or other significant finding. The details were passed to key workers and hospital appointments have been attended. These patients had no symptoms prior to screening.

Specific deliverables will be overseen by our Integrated Care Strategy Working Group to assure the Integrated Care Partnership of progress in 2025/26.  Although it is expected that the definition of deliverables will mature over the first quarter, current expectations are as follows:

Health and Work: We want to support people with their health and wellbeing to enable them to be in employment

What will we do in 2025/26

• Prevention: undertake a mapping exercise with partners to understand the current system response to Health and Work, and wider Fourth Aim ambitions (Net Zero and Social Value).                                                             
• Equity: establish a Health and Work Collaborative across Nottingham and Nottinghamshire and with EMCCA partners to drive delivery of key initiatives e.g. Connect To Health.                                                                  
• Integration: work with targeted communities through Integrated Neighbourhood Teams and Place based Partnerships to improve employment and reduce worklessness through education, skills and employment opportunities across our anchor organisations.              

Promoting the best outcomes for Children and Young People: We want to make sure that babies, children and young people have the best start, are supported with their mental health and children are ready for school

What will we do in 2025/26

• Prevention: develop and implement a refreshed Best Start Strategy across City and County
• Equity: implement the Keeping Children Safe and Helping Families Thrive policy
• Integration: continue to increase coverage of Mental Health Support Teams in Schools                                 

Supporting people living with Frailty and complex needs: We want people to live as healthy as possible into older age

What will we do in 2025/26

• Integration: implement Integrated Neighbourhood Health Teams supporting people with severe or moderate frailty
• Prevention: support people’s independence through the roll out of home devices and sensors     
• Prevention and equity: promote eating and moving including exercise to support people with frailty to stay well for longer and reduce deterioration