NEWS: Call for better Integrated Care Systems

As reported by NHE, NHS experts urge the government to support integrated care systems with more local flexibility and decision-making power

The King’s Fund’s Realising the potential of integrated care systems report looks at ICSs since their official inception two years ago and has found that solving issues in the immediate term has held ICSs back from working towards longer-term goals.

The short term problems revolve around workforce issues — stemming from staff shortages and industrial action. It is thought that there have been 1.5 million cancellations since the strikes started, resulting in around a £3bn bill for the NHS.

Despite this, The King’s Fund has found evidence of progress, particularly through:

• organising around a shared purpose;
• building system leadership;
• encouraging system-focused behaviours;
• scaling and spreading success;
• using resources more effectively; and
• managing complexity.

Health leaders have highlighted realism around progress speed; reinforcing local partnership working; and granting greater flexibility around national funding provision as ways that policymakers can help ICSs succeed.

“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,” said Chris Naylor, who is the report’s lead author and senior fellow at The King’s Fund.

“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.”

The desire for no top-down structural changes is a sentiment that has been echoed across the health sector, notably in the NHS Confederation’s report earlier this year, which outlined how the next government can put the NHS on sustainable footing.

On his first day of office, Wes Streeting announced that the official policy of the Department of Health and Social Care was that the NHS is “broken”. Shortly afterwards, he asked Lord Darzi, lifelong surgeon and innovator, to conduct a “raw and frank” performance review of the NHS, which is scheduled to report back in September. This report will form the basis for government’s long-term NHS reform plans.

Maintaining a long-term outlook on transformation is ultimately one of the actions recommended by The King’s Fund — i.e., ensure the requisite infrastructure and skills are in place for lasting change.

Practising system collaboration and inviting challenge is another recommendation, as is the need to be less focused on the means through which outcomes are achieved and valuing the views of local people, patients and staff.

Naylor added: “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.”

The King’s Fund adds that decision-makers must return to recommendations set out in the Hewitt Review last year. The Health Foundation penned a series of articles for National Health Executive last year in response to the review.

The one year anniversary of ICSs also coincided with the NHS’s overall 75th anniversary — the Health Foundation’s Phoebe Dunn helped break down the integrated care revolution a year from its formalisation and concluded that much of the success hinges on political commitment and will.

This was also a theme in Jonathan Morgan, the Welsh NHS Confederation’s chair, piece in our latest issue, where he outlines how the NHS at 100 can look and how it may be time to reimagine the future.