Blog post

New beginnings for the NHS

As integrated care systems today become statutory bodies, our new ICS Network director Sarah Walter shares her hopes for what is to come.
Sarah Walter

1 July 2022

In the first week of her new role as ICS Network director, Sarah Walter reflects on the significant opportunity that this new stage represents for the NHS and the populations it serves.   

Last week I started in my new role as director of the NHS Confederation’s ICS Network. Pencils sharpened, with a fresh notepad and a long to-do list, but full of anticipation for what is to come. Today marks a new start, as integrated care systems (ICS) become statutory bodies through the establishment of the integrated care boards (ICB), with integrated care partnerships (ICP) to follow shortly after. Perhaps system leaders have also sharpened their pencils and purchased new notepads, but for many the pages are already brimming with ideas, plans and things that need sorting out. In my notebook I have scribbled three words that I would like to reflect as we mark a significant opportunity for system leaders to work with their partners and communities to improve health and reduce inequalities.


I was asked last week if systems were ‘ready,’ and the main basis on which they appeared to be judged was on whether systems had all their senior posts filled. Clearly an overly simplistic criteria to use, but it does prompt the question, what does ‘ready’ even mean?

In setting up these new statutory bodies, the chair and CEO designates (and their CCG colleagues – thank you to all those involved in the preparation work) have had to fulfil a myriad of steps in time for 1 July. A huge amount of work has gone into getting the structures and governance arrangements in place to ensure that these new organisations are able to safely take on their statutory functions.

Nothing is set in stone, and systems will need to continue to flex and learn as they go

Whilst hours have gone into preparing teams, new websites, and sorting governance, what will be crucial for ICS leaders will be setting the culture and behaviours that will drive these new integrated systems. The hope is that this will be one of collaboration, shared learning, shared goals, shared success. We can expect changes beyond the 1 July establishment date as systems try out different approaches and learn what works best within their own local contexts and partnership arrangements. Nothing is set in stone, and systems will need to continue to flex and learn as they go.


ICSs will be rooted in partnership. We know that what keeps people healthy and well includes a much more wide-ranging set of factors than the delivery of high-quality NHS services. Our health is hugely impacted by our housing, our employment status, the green spaces we have access to and our social connections. NHS services will have a crucial role to play, but if we really want to impact the long-term health of our population and address some of the inequalities that we face, we need to be thinking more holistically about the factors at play. This will require ICSs to establish inclusive partnerships that connect NHS and local government statutory bodies with our voluntary and community sector partners, businesses and other public services. As the campaigner Helen Keller said: “Alone we can do so little. Together we can do so much.”


Fundamentally, the success of ICSs will be all about people. The people and communities that they serve. And the people involved in designing and delivering services and support. We know the continued workforce shortage faced in the NHS and social care creates a significant challenge for systems, and ICS leaders will be looking at how they can secure the workforce they need for the future.

ICSs around the country are having special events today for staff and for communities, from stands at country shows to online conferences, all helping to explain this new step in creating the kind of joined-up health and care system that people desperately want. The ICS Network team will continue its work supporting all of our system colleagues as they move into this new phase.

Not everything is going to be right first time, and not every problem can be solved. Real change is going to take time

Not everything is going to be right first time, and not every problem can be solved. Real change is going to take time. But in my role as director of the Confed’s ICS Network, I’ve been struck by the energy and ambition voiced by ICS leaders about the task that they see before them. Let’s give ICSs the backing and support to help make this a success. As Edward Everett Hale, the American author, historian, and Unitarian minister said: “Coming together is a beginning; keeping together is progress; working together is success.” I wish all of our ICS leaders every success as they embark on this journey.

Sarah Walter is director of the NHS Confederation’s ICS Network. You can follow Sarah on Twitter @sarahjwalter