Integrated Care Systems

Integrated Care Systems
Name	Integrated Care Systems
Established	2019
Jurisdiction	National Health Service (England)
Type	Health partnership

Integrated Care Systems

Integrated Care Systems are statutory partnerships created to coordinate health and social care delivery across geographic areas, designed to align National Health Service (England) bodies, local authorities such as London Borough of Camden, clinical leaders like NHS England Chief Executives, and partner organisations including Care Quality Commission, British Medical Association, and local voluntary sector providers. They aim to improve population health, reduce unwarranted variation, and manage resources by bringing together commissioners and providers such as NHS Trusts, Clinical Commissioning Group successors, and community health services across regions like Greater Manchester Combined Authority and Mersey Care NHS Foundation Trust areas.

Overview

Integrated Care Systems operate at place and neighbourhood levels to integrate services delivered by hospital providers such as Guy's and St Thomas' NHS Foundation Trust, ambulance services like London Ambulance Service, mental health trusts such as South London and Maudsley NHS Foundation Trust, and social care teams managed by county councils including Kent County Council. They work with primary care networks comprising general practices represented by organisations such as the Royal College of General Practitioners, as well as with national regulators like the National Institute for Health and Care Excellence. Key aims mirror policy frameworks seen in initiatives like the Five Year Forward View and NHS Long Term Plan.

History and development

Origins trace to policy reforms and integrated care pilots including the Better Care Fund and the Vanguards (NHS) programme, and national reports such as the Acheson Report and the Griffiths Report (1983), which influenced organisational shifts. The legislative formation followed statutory changes influenced by reviews led by figures like Sir David Dalton and policy documents from Department of Health and Social Care (UK). Early adopter footprints appeared in combined authorities such as Greater Manchester Combined Authority and devolution deals including the Devolution in England arrangements. Implementation accelerated after guidance from NHS England and funding rounds tied to national initiatives like the New Care Models Programme.

Structure and governance

Each system comprises partners including acute trusts such as Imperial College Healthcare NHS Trust, community providers like Oxleas NHS Foundation Trust, local authorities exemplified by Birmingham City Council, and independent sector organisations. Governance mechanisms often establish an integrated care board and integrated care partnership, with membership drawn from NHS leaders such as NHS England Chief Executive, council leaders like those in Sheffield City Council, and third-sector chairs from bodies similar to The King's Fund. Accountability lines intersect with regulators including the Care Quality Commission and national funders such as NHS Improvement (now part of NHS England), and incorporate statutory duties under legislation influenced by acts like the Health and Social Care Act 2012.

Functions and services

Systems coordinate elective and emergency care delivered by organisations such as Royal Free London NHS Foundation Trust, public health interventions aligned with offices like Public Health England (now successors), mental health services represented by Improving Access to Psychological Therapies programmes, and community nursing from providers similar to Central London Community Healthcare NHS Trust. They support specialised services hosted by centres like Great Ormond Street Hospital and population health management using datasets curated by entities such as NHS Digital. Workforce planning connects with professional bodies including the General Medical Council and Nursing and Midwifery Council.

Funding and commissioning

Resource allocation combines national allocations from NHS England with pooled budgets negotiated between NHS organisations and local authorities like Lancashire County Council, often using mechanisms reminiscent of the Better Care Fund and capitated payment pilots trialled in Salford Royal NHS Foundation Trust partnerships. Commissioning responsibilities are shared among clinical commissioners’ successors, integrated care boards, and specialised commissioners such as those for tertiary services at institutions like University College London Hospitals NHS Foundation Trust.

Performance and evaluation

Performance assessment draws on metrics used by Care Quality Commission, outcomes frameworks referenced in the NHS Outcomes Framework, and benchmarking against systems such as NHS Wales and international comparators like providers in Denmark or Netherlands. Evaluation has utilised research from universities and think tanks including University of Manchester, The Health Foundation, and King's Fund reports, examining impacts on indicators such as emergency admissions, elective waiting lists, and population mortality.

Challenges and criticisms

Critiques echo issues raised in reports by organisations like National Audit Office and commentators in The King's Fund, noting tensions between collaboration and competition regimes set by laws such as the Competition Act 1998, variable capacity among partners including overstretched trusts like Mid Staffordshire NHS Foundation Trust (historical exemplar), and persistent disparities in areas like Blackburn with Darwen or Tower Hamlets. Concerns include governance opacity, unequal resource distribution across combined authorities such as Tees Valley Combined Authority, and difficulties in data sharing constrained by frameworks involving NHS Digital and information governance regimes.

Category:Health policy