Improving health and care at scale: learning from the experience of systems

The early work of integrated care systems at the forefront of improvement at scale.
Professor Sir Chris Ham

21 November 2023

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Key points

  • NHS England has outlined plans to develop an improvement approach - NHS IMPACT - to support continuous improvement. There are also ambitions for integrated care systems (ICSs) to become ‘self-improving systems’.

  • This report, written and researched by Sir Chris Ham and jointly commissioned by the NHS Confederation, the Health Foundation and the Q community, reviews the experience of a number of ICSs identified as being at the forefront of this work, focusing on the approaches they have taken and the results achieved.

  • Around 40 leaders from across eight systems contributed interviews and data, resulting in eight case studies that illustrate the range of work underway and the results being achieved throughout England.

  • System leaders have been resourceful in ‘going with the grain’ of existing improvement methods, creating improvement and learning communities of experienced staff, and sharing expertise with organisations and services that may lack capabilities.

  • System leaders are ‘learning by doing’ as they seek to bring about improvement through influence and persuasion and build shared commitment to change.

  • There are concerns that the legacy of top-down performance management in the NHS might create barriers to realising the ambitions behind NHS IMPACT. System leaders argue that the work of NHS IMPACT should focus on a small number of national programmes and leave scope for systems to work on local priorities.

  • Leaders should recognise that spreading innovations requires adaptation and skills in taking something that works in one context and making it work in another.

  • The National Improvement Board should use the findings of this report when shaping its strategy and should ensure that expertise in ICSs and other partners is used.

Read Improving Health and Care at Scale: Learning from the Experience of Systems.

Read the report summary.

Download the summary of case studies.

Find out more about Learning and Improving Across Systems, a programme of support for health and care systems from the NHS Confederation, Health Foundation and Q community.