Integrated care: the real deal or just another reorganisation?

As the NHS is working flat out to vaccinate as many people as possible and tackle both high levels of current demand and the large covid backlogs, the new Secretary of State has laid proposed legislation before parliament to implement the recent white paper. This builds on the prior proposals, and will see the NHS gearing itself up for another major reorganisation with the planned introduction of statutory ‘Integrated Care Systems’ (ICSs) from April 2022 incorporating the functions and staff of existing Clinical Commissioning Groups (CCG) but with a much greater remit as the leaders and integrators of local systems.

It represents the dismantling of the ‘internal market’ established by Labour governments in the 1990s and developed under Conservatives in the decades since. The formally declared core organising principle is shifting from competition to collaboration. Will this result in real change in the health outcomes and in people’s experience of joined up care? Or will it, like so many top-down NHS reforms before, default to “just another reorganisation”?

The legislative framework is anticipated to come before parliament for a second reading in late July. It builds on the recent White Paper ‘Integrating Care – Next steps to building strong and effective integrated care systems across England’ which set out the overall direction of travel, how NHS England and NHS Improvement will formally come together and what local systems – partnerships of NHS and councils – will be required to do to meet the ambitions set out in the NHS Long Term Plan.

Partnership within the NHS, and between the NHS and local government is at the heart of the proposals, and a formal duty to collaborate with each other will be prescribed. Statutory ICSs will be formed in each ICS area – most as now but some may change to align geographic boundaries with upper tier local authorities.

The Statutory ICSs will be comprised of an ICS Health and Care Partnership, bringing together the NHS, local government and other partners, and also an ICS NHS Body. The ICS NHS Body will be responsible for the day to day running of the ICS while the ICS Health and Care Partnership will bring together Health and Care partners to develop a plan to address health inequalities, public health, and social care needs.

Obviously, all this ambition for reform comes at a time of continued uncertainty and complexity as partners adjust to ‘living with and beyond Covid’, tackling recovery for both staff and patients with continued workforce shortages, and in the face of financial austerity and the continuing lack of a coherent and properly funded social care policy. This makes for an inevitable ever-increasing pressure to do more with less.

We also know that despite huge effort and sincere commitment, integration and improvement is difficult. People and communities often have not received joined up care and support built around their needs. Their experience and outcomes are often sub-optimal as covid has mercilessly exposed, whilst resources are wasted, and staff health and wellbeing harmed.

The redesign and development of new statutory Integrated Care Systems with corresponding empowered local places, enhanced provider collaboration, and much greater alignment and potential for integration across the full remit of Council and NHS activities, I believe, represents a once in a generation opportunity to improve the health and care of people and communities.

So how can we all ensure this opportunity is grasped? We will be exploring this from different angles on ICS development over the coming months – sharing evidence, experience, insights and views from a range of guest contributors and our team.

More useful information on Integrated Care Systems can be found on the NHS England website at https://www.england.nhs.uk/publication/integrated-care-systems-guidance/