The bodies set up to redesign health and care services around the changing needs of the population are being held back from fully delivering improvements for their local communities because of underinvestment in workforce and capital – and a lack of a social care workforce plan.
That’s according to a new report from NHS Confederation, ‘The state of integrated care systems 2022/23: Riding the storm’, which has sought the views of leaders across the country’s Integrated Care Systems (ICSs) in their first year as formal partnerships of health organisations, local authorities and other bodies.
ICSs have been tasked with overseeing the planning of services, improving health outcomes and reducing inequalities across 42 local areas in England.
Their development was a major structural change for ensuring healthcare in England is delivered in a more joined-up way when they were formally established as part of the Health and Care Act in July 2022.
In the survey, ICS leaders cited workforce pressures, issues with social care, and financial constraints as their main challenges, echoing the findings of reports by the National Audit Office and Public Accounts Committee which warned that ICSs would find it difficult to deliver on their long term aims unless these issues are tackled.
ICS leaders told the NHS Confederation that these challenges (and the disruption of industrial action in the last 12 months) make the task of balancing long-term transformation and short-term operational delivery significantly more difficult.
Sarah Walter, director of NHS Confederation’s ICS Network, said:
“ICS leaders are proud of the progress they’ve made in really tough conditions but they are deeply frustrated by some of the potentially soluble barriers that are hindering the extent to which they can get on with transforming services for their local communities. They want to see these tackled urgently if ICSs are to fulfil their full potential.
“Workforce pressure was cited as the biggest issue, closely followed by finances, with a call for the promised review of the entire NHS capital regime to progress without delay. ICBs are also concerned about having to reduce their running costs by 30% over the next two years, and the risk that this adds further pressure and absorbs management time and headspace in a context where the number of functions being delegated to ICSs continues to increase.
“A further barrier holding back the progression of ICSs is the government’s refusal to commit to a long-term workforce plan for social care.
“While it is encouraging that ICSs are recognised as the right model at the right time for health and care, more concerted action is needed to create the right conditions to help them succeed in delivering even better, more joined-up care for patients.”
The survey suggests that ICS leaders feel they have made good headway, with relationships and foundations forming, as well as some positive changes being made at a national level – including shorter and more focused operational planning guidance for the NHS and structural changes to NHS England – but are concerned that the asks of ICSs have grown while resources have been cut.
They are urging national bodies and the government to take a number of actions, so ICSs can effectively deliver for the populations they serve and reach their full potential.
To best support ICSs in year two of their existence as statutory bodies, leaders want to see:
- Social care workforce plan - We welcome the NHS Long Term Workforce plan but call on the government to develop an equivalent plan for the social care workforce to recognise the contribution and value of this sector.
- Capital spending review - We support the government’s commitment to reviewing the entire NHS capital regime in response to the Hewitt review. We call on the government to include in this review the amount of capital funding as well as the complex allocation process.
- Support for new commissioning functions - NHSE should work closely with ICBs to ensure that they have access to the data and the capacity they need to effectively discharge their new commissioning functions.
- Devolve to evolve - As the Hewitt review and the Health and Social Care Select Committee proposed, DHSC and NHSE should focus on setting a small number of targets based on outcomes and give ICSs the freedom to innovate in how they deliver against these.
- Co-production - Through their response to the Hewitt review and new operating framework, DHSC and NHSE have committed to embedding a co-production approach. Co-production of policy and guidance impacting ICSs should become the norm. This should include, in particular, work on system accountability arrangements.
While leaders are clear on what needs to be done to support ICSs, they remain positive about the work they are doing, with nine in ten ICS leaders saying that partners within their local systems are working collaboratively to set and deliver on their key priorities. The same proportion also reported that their integrated care board (ICB) and integrated care partnership (ICP) are working well together.
They are also positive about the new functions ICBs have recently taken on, including the commissioning of community pharmacy, optometry and dentistry (POD) services. Most leaders surveyed felt very or moderately well prepared to take on each of these additional functions: nine out ten ICB leaders felt prepared for pharmacy and optometry services and seven out of ten for dentistry. However, they highlighted concerns around the lack of appropriate and high-quality data for many of the services, as well as significant challenges in dentistry linked to the national dental contract.
As well as examining the progress that local systems have made, the report explores where leaders feel there are opportunities for further development, with devolved decision making a priority area.
The research found that ICS leaders remain committed to devolution to place-based partnerships and provider collaboratives as they mature. However, despite this commitment and intention, only 45 per cent of survey respondents felt that their ICS currently devolves decisions to the most local level, as close to local communities as possible, but said that this was a priority for their next stage of development.
Notes to editors
We invited leaders of the 42 integrated care systems in England to share their views on ICS development through a national survey, which was open to chief executives and chairs of integrated care boards (ICBs) and chairs of integrated care partnerships (ICPs). The survey ran from 14 March to 25 April 2023. We received 47 responses overall, representing 36 out of 42 systems – over 85% of systems. Responses were split across 19 ICB chairs, 16 ICB chief executives, 6 ICP chairs and 7 joint ICB/ICP chairs. Some of the questions were asked specifically to certain respondents, such as ICB and ICP chairs.
In order to complement and test our survey findings, we ran five roundtables throughout April and May 2023, with key stakeholders from across community and mental health, acute and ambulance providers, primary care and place leaders, Voluntary, community and social enterprise (VCSE) partners and local government. We also undertook individual interviews with seven survey respondents to explore their answers in greater depth.
At times we have compared to last year’s survey, but comparison is limited by different wording of questions and the individuals completing the survey. As the first year of formal ICS partnerships, we intend to use this year’s survey as a baseline for ICS progress going forward.
We are the membership organisation that brings together, supports and speaks for the whole healthcare system in England, Wales and Northern Ireland. The members we represent employ 1.5 million staff, care for more than 1 million patients a day and control £150 billion of public expenditure. We promote collaboration and partnership working as the key to improving population health, delivering high-quality care and reducing health inequalities.