Roger Greene


Integrated Care Systems Let’s big up Places and Neighbourhoods!

Roger Greene continues our series on the development of integrated care in England. With the government introducing legislation, we are exploring different aspects of ICS development over the coming months – sharing evidence, experience, insights and views from a range of guest contributors and our team. This week Roger wants to ask the question about who is best placed to lead the necessary collaborations there so Integrated Care Systems can operate as whole systems in all their complexity.

To read other blog posts within this series, click on the link below.


Now the dust is settling on the boundaries of the Integrated Care Systems (ICSs) as soon-to-be legal entities from next April, we want to shift our focus to Places and Neighbourhoods and ask the question about who is best placed to lead the necessary collaborations there so ICSs can operate as whole systems in all their complexity.

The NHS is about to lose CCGs and will have Integrated Care Systems in the NHS with the duty to collaborate with Local Authorities to deliver joined up population-based strategies. What were called Places a decade ago (e.g., Greater Manchester) are now called Integrated Care Systems, but the concept of Place has been revived as a critical component for planning and resourcing support and services, only now more local than regional.

Crucially the ICS architecture recognises Communities and Neighbourhoods as the critical next level of the system below Place. In parallel with that, the COVID vaccination programme has evidenced clearly in many parts of the country that low vaccination rates prevailed in “hard to reach” communities with high levels of deprivation and high health inequalities.

The NHS mindset tends (with honourable exceptions) to think Primary Care is the way into these communities, and while Primary Care Networks will be fundamental to success, the emerging evidence from the COVID vaccination programmes shows these communities are often better reached through some “unusual suspects” for Health and Care, like the Voluntary and Faith sectors, Environmental Health Officers and Health and Safety Officers to name but a few who know their communities, businesses and workplaces like the backs of their hands. These are fundamentally the business of Local Authorities either to nurture or to provide. Think about School Nurses too – often what they don’t  know about families in the area isn’t worth knowing! This is the business of Education.

Our point? If ICSs are going to achieve their ambitions the NHS will have to step back from wanting to lead in areas where there are already natural leaders from other agencies, and instead shift to collaborator mode. Don’t try and muscle in. Local Authorities are usually more natural leaders in this space, or people they know and trust. They have already put in the hard yards on community development over decades. They see populations as citizens with responsibilities as well as rights, not as patients or patients-in-waiting. They are the people charged with developing the Joint Strategic Needs Assessments (JSNAs) for the populations they serve.

It isn’t easy, after decades of competition, commissioning and central command and control for NHS leaders and practitioners to change behaviours and make way for others to lead. It will need a lot of unlearning of conditioned behaviours. But the pain is necessary if the holy grail of improved population health and reduced health inequalities is to be achieved.

In our blog we will start exploring how to change those conditioned behaviours and shift to a more collaborative mind-set.


More information on Integrated Care Systems can be found at

We have 7 key insights to share with you from our work over many years in health and care. All developed through dialogue and engagement around clear vision. True systems leadership in action.

Our 7 key insights are;

  • Why, why, why? – Ensure shared clarity of purpose around the needs of patients and communities,
  • Dual purpose design – resourcing multiple purposes,
  • Mind the gaps – understanding and respecting difference,
  • Design Principles – translating strategic clarity,
  • Identify and manage the tensions – or they will manage you,
  • Make the right thing the easy thing – enabling processes, and
  • Build trust momentum – growing systems leadership.

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