There are many changes in play currently in the way the NHS is structured, not least the transition to Integrated Care Systems (ICSs) in England - with the Health and Care Bill setting out how health and social care should be integrated - and the creation of integrated care systems (ICSs), set out in NHS Long Term Plan. ICSs were set to be put on a statutory footing from April 2022, and there has naturally been a huge amount of guidance produced in order to ensure the creation of strong and effective ICSs across England.
The transition to ICSs is part of a huge shift in the way health and care is organised, moving towards collaboration and the integration of services. This transition is central to the delivery of the Long Term Plan and has at its core the redesign of care and the bringing together of organisations who are local to one other to improve population health and create shared leadership and action. This is sometimes referred to as the ‘triple integration’ of primary and specialist care, physical and mental health services, and health with social care.
What is an Integrated Care System (ICS)?
The creation of ICSs represents the culmination of the ambitions set out in the NHS Long Term Plan and demonstrates the overall commitment to collaborative action in order to improve health outcomes for the population.
Let’s look at the definition of ICSs, which are described as: ‘partnerships of health and care organisations that come together to plan and deliver joined-up services and to improve the health of people who live and work in their area.’
They are also described as: ‘geographically based partnerships that bring together providers and commissioners of NHS services with local authorities and other local partners to plan, co-ordinate and commission health and care services.’
ICSs have four key aims, which are set out in the November 2020 NHS England and NHS Improvement document 'Integrating care: Next steps to building strong and effective integrated care systems across England'
These are to:
- Improve outcomes in population health and healthcare
- Tackle inequalities in outcomes, experience and access
- Enhance productivity and value for money, and
- Help the NHS support broader social and economic development
ICSs are designed to tackle the complex health challenges faced by the NHS in England, including:
- Improving the health of children and young people
- Supporting people to stay well and independent
- Acting sooner to help those with preventable conditions
- Supporting those with long-term conditions or mental health issues
- Caring for those with multiple needs as populations age
- Getting the best from collective resources so people get care as quickly as possible
But it’s not just health and social care that are key to the success of ICSs. In February 2021, when NHS England and NHS Improvement made recommendations to the Government to establish ICSs on a statutory basis, they also set out strengthened provisions to ensure that local government could play a full part in ICS decision-making. These proposals were adopted in the Government’s White Paper ‘Integration and Innovation: working together to improve health and social care for all.’
Managing the transition to ICSs
NHS England and NHS Improvement (collectively known as NHSEI) and the Government have set out plans to put ICSs on a statutory footing and have published a wide range of guidance and resources to help support this move towards ‘place-based partnership working’.
NHSEI are really focused on collaborative and joined up working across the NHS, in order to meet challenges such as tackling backlogs and longstanding health inequalities set out in the ‘Integrated Care Systems: design framework’, published in June 2021, in the midst of the COVID-19 pandemic.
The journey to getting there can be broken down four key phases: preparation, implementation, transition and going live. So, let’s look at them all in turn.
In this crucial stage, ICSs are expected to identify their functions, leadership, capabilities and governance, while creating and updating their System Development Plans (SDPs) and ensuring they are aligned against the key implementation requirements. Plans are expected to be put in place which will help them manage the transition phase – while also taking into account any changes that could take place to ICS boundaries.
A further document ‘Thriving places - Guidance on the development of place-based partnerships as part of statutory integrated care systems’ states that leaders should ‘confirm their proposed place-based partnership arrangements for 2022/23, including their boundaries, leadership and membership.’ The preparation phase will also need to be the time when plans are prepared for managing both organisational and people transitions.
To support the implementation process, NHSEI has shared the feedback from engagement before this phase, saying: ‘We heard throughout our engagement that national organisations should not mandate how ICSs go about taking account of the principles set out in this document; they should be left to locally determine the right approach. That said, we also heard that now is the perfect time to reflect and be ambitious on this agenda. We encourage systems to be systematic in their assessment of current arrangements, considering how they could meet the core requirements set out in above and how they could achieve ‘what good looks like’.
NHSEI have said that they will put in place support systems to implement guidance on creating new ICSs, and will encourage working in partnership with local government, social care, public health and other professional partners. NHSEI have also committed to supporting systems in leadership development with general management training and coaching and mentoring, to aid new ways of working.
To support the transition to ICSs, NHSEI have published a huge amount of guidance and resources and continue to do so. They have engaged with stakeholders across England, with the aim to support health and care leaders to build strong and effective ICSs across the country.
They talk about the transition phase thus: ‘The months leading to April 2022 will be a time of transition as ICSs continue to deliver recovery and their core purpose, while system leaders and partners prepare for the anticipated establishment of statutory Integrated Care Boards (ICBs) (subject to the enactment of the legislation). NHS trusts and foundation trusts will play an important role in this transition period as constituent members of their systems. They will help lay the foundation for Integrated Care Boards to take on their specific functions.’
We can see a real focus on multi-professional clinical and care professional leadership which is seen as central to designing and delivering integrated care and meeting the complex needs of people: ‘As we transition to the proposed new statutory arrangements for ICSs, the full range of clinical and care professional leaders, from a diversity of backgrounds, should be involved in decision-making throughout the ICS so they can share and contribute towards a collective ambition for the health and wellbeing of the population.’
As with the previous phases of the transition to ICSs, NHSEI will provide support and guidance for the Go Live stage. This NHS website sets out a library of resources that will support this phase - from guidance on working with people and communities to guidance on partnerships with the voluntary, community and social enterprise sector.
In 'Integrating care: Next steps to building strong and effective integrated care systems across England' NHSEI say: ‘We will work with systems to ensure that they have arrangements in place to take on enhanced roles from April 2022. We will set out a roadmap for this transition that gives assurance over system readiness for new functions as these become statutory.’
At current time of writing, there is talk of a delay in the go-live of April 2022.
NHSEI expectations for ICSs and the ICS design framework
There are a huge number of NHSEI expectations for ICSs – not least a system wide partnership board, place leadership arrangements, provider collaborative leadership and individual organisational accountability. Let’s take a look at the ICS design framework to find out more.
The ICS Design Framework is an ambitious document that builds on previous reports to set out next steps and how NHSEI expect to see ICSs to operate when they go live. While highlighting that there are still major operational challenges across the NHS, it goes on to state the critical role that ICSs will play in achieving the key aims, which are to ‘improve outcomes and tackle inequalities, to enhance productivity and make best use of resources and to strengthen local communities.’ The document renews the importance of collaboration and the speed required to achieve key changes.
While the framework ‘does not aim to describe the full breadth of future ICS arrangements or the role of all constituent partners, it drills down into on how they expect the NHS to contribute,’ it is written as an outline for non-NHS organisations on how the NHS will be transitioning to ICSs.
It also sets out how ICSs can use legislative reform to remove barriers to integrated care, and talks about the governance and management arrangements that each ICS will need to set up to carry out those functions.
Key elements it goes on to talk about are:
- the opportunity for partner organisations to work together as part of ICSs to agree and jointly deliver shared ambitions
- key elements of good practice that will be essential to the success of ICSs, including strong clinical and professional leadership, deep and embedded engagement with people and communities, and streamlined arrangements for maintaining accountability and oversight
- the key features of the financial framework that will underpin the future ambitions of systems, including the freedom and mechanisms to use resource flexibly to better meet identified needs and to manage financial resources at system level
- the roadmap to implement new arrangements for ICS NHS bodies by April 2022 to establish new organisations, appoint leadership teams to new statutory organisations and to ensure that people affected by change are offered a smooth transition that allows them to maintain focus on their critical role in supporting recovery from the pandemic
‘An ICS brings together local organisations to redesign care and improve population health, creating shared leadership and action.’ As we have explored in this article, ICSs are a hugely anticipated change in the way that healthcare will be delivered across the NHS and are central to the delivery of the Long Term Plan.
The creation of ICSs will involve a huge amount of collaboration across health and social care, which will in turn improve health outcomes across the population.