The Kings Fund - Clear signs integrated care systems are making progress but will need greater local flexibility to real

Two years since integrated care systems (ICSs) were formally created and with the new government confirming it is committed to the current structure of the NHS, The King's Fund is calling on national bodies to do more to create an environment in which ICSs can succeed.

Despite facing staff and budget cuts shortly after their inception, researchers at the health and care think tank found that many ICSs are showing signs of progress. However, in a new report from The King's Fund Realising the potential of integrated care systems, the authors warn that incredibly high pressures on health and care services, an intense political focus on hitting key national targets such as driving down waiting lists, and extremely difficult economic circumstances could derail the improvements ICSs are intended to bring about.

The King's Fund argues that for ICSs to reach their full potential, the new government and national bodies will need to give them the best possible chance of success by ensuring they are held to account in a way that reinforces local partnership working rather than undermines it, and by giving them greater flexibility to use national funding in ways that best meet the needs of local people.

ICSs bring together NHS organisations, local authorities, charities and other partners in an area. As well as commissioning local health and care services, ICSs were set up to tackle long-standing issues in the health and care system, such as workforce shortages, in a more joined-up way, and to deliver more co-ordinated care for patients across services. The 42 ICSs that cover England are responsible for spending over £100bn of NHS funding.

The report's authors studied how partner organisations in several ICSs are working together to tackle workforce challenges, such as the recruitment, training and retention of health and care staff in their area. They found clear signs that progress is being made, such as organising local partners around a shared purpose, scaling and spreading success, and using resources more effectively. But success has been uneven and difficult - with the past two years being among the most challenging in the NHS's history.

The authors conclude that ICS progress has been slowed by the need to focus on resolving immediate issues - for example, industrial action has meant that NHS trusts have often been focused on maintaining safe staffing levels rather than supporting their ICS to do the transformative work needed to redesign the workforce of the future.

ICSs became statutory bodies under the 2022 Health and Care Act, although health and care organisations have been taking a more joined-up approach to planning and delivering services for more than a decade. The formalisation of ICSs marked a major shift away from the doctrine of competition between different organisations towards collaboration and co-ordination across services.

With the public struggling to access timely care, and pressure to drive down waiting times, The King's Fund argues that national leaders should avoid the temptation to undermine local partnership working through heavy-handed, top-down performance management. The authors call on national bodies to set clear outcomes for ICSs to deliver but to allow flexibility in terms of how those outcomes are achieved.

The team behind the study also recommend that politicians and national leaders be realistic about the speed at which ICSs can bring about improvements to care, given the challenging context they are working in.

Chris Naylor, Senior Fellow at The King's Fund and lead author of the report, said:

“ICSs were born into a storm, but despite their rocky start, there are now signs of the benefits brought by more collaborative working through these structures. The new Secretary of State for Health and Social Care has committed to avoiding imposing further structural changes in the NHS, which means the challenge is to make sure ICSs now have the best possible chance of driving improvements for patients.

“Central to this is avoiding the temptation to tie their hands with nationally dictated actions; instead, ICSs should be held to account for achieving outcomes while allowing them the freedom to achieve those outcomes in the most effective way for their area.

“Much of the work that happens within ICSs goes unseen. We found that where system working is functioning well, changes have been underpinned by the efforts of local leaders to strengthen relationships between their organisations, change mindsets and culture to one of collaboration, and encourage different behaviour within their system.

“Those working in health and care systems made clear that the government must return to the recommendations set out in the independent review of ICSs led by the Rt Hon Patricia Hewitt last year, such as shifting away from a culture of top-down performance management to one of learning and improvement.”