Joining up care leads to better outcomes for people. When local partners – the NHS, councils, voluntary sector and others – work together, they can create better services based on local need.
Integrated care systems, (ICSs) have been set up to make this happen. Their aim is to improve health and care services – with a focus on prevention, better outcomes and reducing health inequalities.
The 42 ICSs in England are local partnerships that bring health and care organisations together to develop shared plans and joined-up services. They are formed by NHS organisations and upper-tier local councils in that area and also include the voluntary sector, social care providers and other partners with a role in improving local health and wellbeing.
ICSs were legally established on 1 July 2022, covering all of England. These new arrangements build on partnerships that were already in place across the country.
They aim to:
- improve outcomes in population health and healthcare
- tackle inequalities in outcomes, experience and access
- enhance productivity and value for money
- help the NHS support broader social and economic development
The NHS organisations and upper-tier local authorities in each ICS run a joint committee called an integrated care partnership (ICP). This is a broad alliance of partners who all have a role in improving local health, care and wellbeing. They may also include social care providers, the voluntary, community and social enterprise sector and others with a role in improving health and wellbeing for local people such as education, housing, employment or police and fire services.
Each ICP must develop a long-term strategy to improve health and social care services and people’s health and wellbeing in the area. They may also take on additional responsibilities, as agreed locally between the members.
integrated care boards (ICBs) are NHS organisations responsible for planning health services for their local population. There is one ICB in each ICS area. They manage the NHS budget and work with local providers of NHS services, such as hospitals and GP practices, to agree a joint five-year plan which says how the NHS will contribute to the ICP’s integrated care strategy.
Upper-tier local authorities are responsible for social care and public health services in their ICS area, as well as other vital services that contribute to health and wellbeing such as housing, education, leisure and transport. They must have regard to the ICP’s integrated care strategy when planning and making decisions.
Other partners bring their own unique contribution to each ICS, including:
Voluntary, community, faith and social enterprise organisations bring their local expertise in working with people in the communities where they live.
Social care providers bring expertise in supporting wellbeing and independence for people with disabilities, with mental ill-health and older people. They provide specialist care and support to people who can no longer live independently.
Partners from other areas like housing, employment, education, justice and business have a critical role in addressing wider determinants of health and wellbeing for individuals and communities.
Developing local arrangements
ICSs have the flexibility to make their own decisions about how partners work together in their area. This will depend on factors like size, geography and population, how many health and care organisations there are and how they have worked together before.
Most larger ICSs have a number of place-based partnerships that design and deliver integrated services for particular areas within the ICS. This might be a particular town or borough. Like the ICP, they involve a range of people interested in improving health and care, including the NHS, local councils, the voluntary, community and social enterprise sector, and other local organisations, working alongside local people.
Provider collaboratives bring together providers of local services to plan, deliver and transform. They are partnership arrangements of at least two trusts, working across multiple places with a shared purpose. NHS England has asked all acute and mental health trusts to be part of a provider collaborative, and some include independent providers.
They have the flexibility to decide what to deliver locally in discussion with ICS partners, including:
- reducing unwarranted variation and inequality in health outcomes, access to services and patient experience
- improving resilience, such as providing mutual aid
- ensuring there is specialisation and consolidation of services, where this will provide better outcomes and value.
People are living longer with more complex conditions. Evidence shows that as well as access to good quality healthcare, it is the wider conditions of people’s lives – housing, income, employment and environment – that have the greatest impact on their health. Services that support people with these issues all have a role to play in improving people’s health.
This means the NHS, local government, the voluntary sector and wider partners must create joined up services that rethink how care is delivered. Care that meets the current needs of local people, and that also aims to prevent people’s health getting worse.
ICSs were created to encourage and enable this. They bring local organisations together with a duty to collaborate, to understand how the health and wellbeing of local people can be improved, agree priorities and strategies for achieving this, and plan different ways to deliver care.
ICSs put the budget and decision making into the hands of local partnerships who will work with local communities to decide how best to design and deliver efficient services that meet local needs and avoid duplication.
These changes build on years of partnership working and change, led by local organisations themselves. ICSs provide the flexibility for local partners to develop and agree how local teams are formed and decisions are made.
What are the benefits?
- Allowing organisations to an act sooner to help people with preventable conditions.
- Supporting people to stay well and independent.
- Caring for people with multiple needs as populations age.
- Using collective resources as effectively as possible, so people receive care as quickly as possible.
- Supporting people with long-term conditions or mental health issues.
- Improving the health of children and young people.
ICSs bring organisations together to join up health and care services, so that people can get the support they need, in the right place at the right time. This means:
- Developing joined up services across sectors: in parts of the country, fire service staff are supporting frail elderly people when they return home from hospital, while others are setting up forums with housing providers, or working with local colleges and employers to equip people with skills and jobs.
- Partnerships between the NHS and local government: supported by their jointly developed integrated care strategies.
- A single approach to workforce: so people can take on new roles, enhance their skills and work more flexibly across different organisations.
- A focus on prevention: using data and population health management approaches to pro-actively identify local people most at risk and the services they might need.
- Devolving to ‘place level’ within a system: bringing local people and partner organisations together to decide what services are needed, and setting up integrated neighbourhood teams to deliver them.
- Setting up integrated neighbourhood teams: through joined up working of professionals across primary and secondary services, social and voluntary sectors that use data and personalised care approaches to understand and address the holistic needs of people.
- Joint working in provider collaboratives: local providers working together across multiple places to reduce unwarranted variation of services, share resources so they can be more resilient, and providing specialist or consolidated services where this brings better outcomes and value for money.
- Supporting local social and economic development, through early intervention, reducing poverty and enhancing the NHS’s role as a major employer.