How Integrated Care Systems Need to Fly the NHS Nest To Find Their Feet Amid Winter Pressures

As the proud parent to 42 Integrated Care Systems (ICS) across the country, NHS England continues to keep a watchful, if somewhat nervous eye, on how each system is meeting their local healthcare needs in their tentative first steps.

With ICSs having been born into a perfect storm of capacity, workforce and funding pressures encircling the NHS, it is understandable the NHS wants to be both protector and guider in chief for the locally-led partnerships which did not exist just seven months ago.

To recap, ICSs are partnerships that unite NHS organisations, local authorities, and social care services to take collective responsibility for planning and delivering health and care services to meet four core purposes:

  • Improve populations health outcomes.
  • Reduce healthcare inequalities.
  • Improve productivity.
  • Enhance NHS contribution to social economic regeneration.

As the Government searches for the solution to the turbulent tide of healthcare challenges sweeping across the country, how do ICSs support this quest and what do they need to stand a chance of succeeding and avoid being blown off course?

Crucially, to what extent does handholding from the NHS form part of the solution?

Does one size fit all

As part of a deep-dive look at rethinking the health and care system to meet patient needs, this week the BBC’s Panaroma programme explored locally-led innovation and the broader role of integration.

The Jean Bishop Integrated Care Centre in Hull served as the case study to show partnership working at its best to support a patient’s need. The centre was the first of its kind when it opened four years ago, and the result is that one patient was able to have a full-body and life check-up in around one hour.

This sounds idyllic, and exhibits the values any form of partnership working should seek to achieve. So why is the NHS not mandating centres of this kind across the country?

The answer to this question came from the centre itself. The Jean Bishop Centre works within its ICS to support preventative needs in response to local healthcare needs, and whilst proud of the centre’s offering, Humber & North Yorkshire ICS told Panorama that replicating it across the country may not work for everywhere.

To help shape local healthcare in a national context, NHS England has imposed a range of national targets to drive up performance in each ICSs. However, does a top-down approach run the risk of undermining the very purpose of ICSs in meeting local needs?

Current challenges

Part of the solution to the storm raging across the health system was the Adult Social Care Discharge Fund, £250mn discharged centrally by the Government centrally to the NHS, and has been designed to support communities’ specific needs. Whilst any available support has been welcomed by ICSs, challenges have been posed by the fund’s implementation, according to the NHS Confederation.

As part of an inquiry launched in July 2022 into the accountability and autonomy of ICSs, MPs sitting on the Health and Social Care Select Committee heard this week from Sarah Walter, Director at NHS Confederation ICS Network.

She highlighted that while the funding was agreed in October 2022, the centrally-led scheme saw ICSs only being paid in December 2022. Ms Walter pointed out that the terms of the fund was “very rigid in terms of what ICSs could spend their money on”.

In her view, ICSs have been constrained at a time of critical need, and where each is at a different stage of their development meaning each will have different, locally-driven needs.

Scrutiny

The Select Committee also heard how the NHS needs to break old habits to embrace new ways of working. Steve Brine MP, the committee’s chair, astutely noted that “like parenting, [the NHS] needs to let ICSs go to the rec”.

This theme permeated the entire hearing and much of the focus on evaluating the role and future success of ICSs.

Nicholas Timmins, Senior Fellow at the King’s Fund, pointed to the “NHS being famous for a commander central overview”. Given that conceptually ICSs are designed to be adaptable to their locality’s healthcare needs, this is at odds with the culture Mr Timmins referred to at the hearing.

He added that there’s a balance to be found between autonomy and accountability, which leads us to the Health Secretary Steve Barclay appointing former Labour health secretary Patricia Hewitt to complete an independent review of “the oversight and governance of ICSs” needed to enable them to succeed.

Recommendations from the review are due to published at the end of January, combined with the select committee’s own findings, we could soon see the extent to which ICSs can spread their wings.

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