PEOPLE FIRST: Risk sharing

Page last updated: 28 April 2023

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Introduce shared management across the integrated care system (ICS). This requires system partners to be open with each other about risks, so shared management teams can make informed decisions.

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People should receive care in right setting for their healthcare needs, irrespective of service demand. Although the majority of integrated care systems can manage demand at normal levels, few are well equipped to deal with excess demand.

Often, this excess demand builds up and manifests in urgent and emergency care (UEC) systems. But it is important to understand that this is often symptomatic of pressure elsewhere in the wider ICS.

The visual of ambulances queued outside emergency departments is only part of the story. For each person waiting in an ambulance waiting to be admitted, there may be many other urgent calls in the community or general practice that still need a response. Professor Keith Willett’s letter addressing ambulance handover delays from 2017 states:

"The patients in the urgent care pathway who are at highest risk of preventable harm are those for whom a high priority 999 emergency call has been received, but no ambulance resource is available for dispatch."

All UEC system risks should appear on integrated care board (ICB) risk registers. Also, system leaders should aim to share risk, not just across individual hospitals, but the wider system too.

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Examples of good practice and innovation

Risk mapping
North East London ICS

Systems benefit from communication in real-time and the ability to map risks across:

  • individual hospitals
  • across other services such as ambulance services, mental health trusts and local authority care providers.
  • the rest of the ICS

The risks taken by each service are likely to differ, as may the time when they occur. Mapping where and when risks occur across the system means leaders can minimise potential harms by ensuring:

  • visibility
  • accountability
  • shared risk across the system.

Integrated care systems can also use risk maps to track improvements and deteriorations between sites. See this example used by North East London ICS: