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ICSs show real potential for sustainable improvements after first year

Desire for rapid change must be balanced against realism on scale and complexity of task ahead

Louise Prime

Friday, 21 September 2018

Integrated care systems (ICSs) are showing encouraging signs of progress and real potential for sustainable improvements in health and care services even though they have only been operating for a year, The King’s Fund has reported*. But it said ICSs must now set tangible improvements in services and outcomes as their key priority, and added that the desire for rapid change must be balanced with realism about the scale and complexity of what is being attempted.

NHS England announced ten areas to develop the first ICSs in June 2017, a further four were selected in May 2018, and more will follow; they were proposed as the future model for the health and care system in England. The report’s authors said their development “represents a fundamental and far-reaching change in how the NHS works across different services and with external partners”, but because there is no national blueprint their development has been locally led.

So that The King’s Fund, an independent charity, could understand how ICSs are developing and identify emerging lessons for local systems and national policy-makers, it conducted interviews with 72 NHS and local government leaders, and other stakeholders, to examine progress in eight of the first-wave ICSs: Bedfordshire, Luton and Milton Keynes ICS; Berkshire West ICS; Buckinghamshire ICS; Dorset ICS; Frimley ICS; Lancashire and South Cumbria ICS; Nottingham and Nottinghamshire ICS; and South Yorkshire and Bassetlaw ICS. It published the resulting report* yesterday.

It found wide variation in the systems’ size and complexity, with the larger ones working to improve health and care through neighbourhoods and places as well as across whole systems, emphasising the principle of subsidiarity.

It said most ICSs are making progress in developing their capabilities to work as systems, and organisations are working more collaboratively to manage finances and performance in a way that was not happening previously. It also found some early signs of progress in delivering service changes, particularly in relation to strengthening primary care, developing integrated care teams and reviewing how specialist services are delivered. But it noted: “It is early days, and more time is needed to embed these changes and determine their impact.”

Factors that helped progress in local systems included: collaborative relationships; shared vision and purpose; system leadership; clinical leadership and engagement; partnerships with local authorities; a meaningful local identity; established models of integrated working; stability of local finances and performance; funding to support transformation; and a permissive and supportive national programme.

On the other hand factors that posed barriers to progress included: the legislative context does not support the system working; a legacy of competitive behaviours; regulation and oversight is not aligned behind ICSs; frequently changing language and the lack of a clear narrative; leaders face competing demands; and funding pressures can both help and hinder progress.

The King’s Fund authors said the challenge now is to build on the foundations that have been laid by removing such barriers and giving ICS leaders both time and support to take their work to the next stage of development. It argued: “As this happens, the understandable desire to see change happen quickly needs to be married with realism about the scale and complexity of what is being attempted.”

They concluded: “ICSs have only been in operation for a year, but there are encouraging signs of progress. The evidence reported here shows that partner organisations and their leaders are working more collaboratively to manage performance and finances across a system in a way that was not happening previously. Evidence of tangible improvements in services and outcomes is limited to date, but this is to be expected given the brief time ICSs have been in existence. This must be a key priority for all ICSs going forward. We found broad consensus that the ICS model has real potential to bring about improvements in health and care, and to place services on a sustainable footing.”


*Charles A, Wenzel L, Kershaw M, et al. A year of integrated care systems: Reviewing the journey so far. The King’s Fund; published 20 September 2018. ISBN 978-1-909029-87-3.

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