Unlocking the NHS’s social and economic potential: creating a productive system

Explore what social and economic development is, why it matters to the NHS and how ICSs can develop more productive systems.
Michael Wood

9 December 2022

Key points

  • Integrating Care: Next Steps to Building Strong and Effective Integrated Care Systems Across England, published in November 2020, described one of the four core purposes of an integrated care system (ICS) as being to help the NHS support broader social and economic development.
  • This purpose is perhaps the least well defined and understood in traditional NHS management and strategy terms, yet is particularly important given the wider ongoing impact of the pandemic and the inextricable relationship between health and socioeconomic outcomes.
  • This report is the first published resource for ICS leaders on this core purpose and builds on significant cross-sector leadership engagement. It sets out in detail what social and economic development is, why it matters to the NHS and vice versa, how ICSs might deliver against this purpose for the benefit of its populations and where next this form of broad, strategic partnership working might lead system thinking.
  • We found from our discussions that there is widespread support for this new ICS purpose, from those leading systems, from the existing NHS leadership, and from both new and traditional partners. Going further, understanding how and where the NHS can support social and economic development was itself thought of as a key test of how the new structures will work more broadly and whether this time, ‘things really will be different’. This is an important reminder of the persuasive power of this purpose and the central role it should play in wider integrated care strategic planning and communications.
  • The current context in which ICSs are beginning to shape their approach to this purpose matters. An engaged ICS can not only broaden its own traditional prevention and population health planning to include new partners, such as the private sector and external resources, they can themselves chip away at the growing inequalities communities are facing and influence the future direction of local social and economic development – moulding an economy and place that supports health in everything it does.
  • The NHS Confederation has led the public discourse on understanding the links between the health sector and the economy for several years, articulating the value of the NHS as an anchor in both national policy and local practice. We believe that this core ICS purpose reflects the next phase of the anchor journey – moving from an institutional view of what one can do to a system view of what we can change.
  • At the heart of this report is a model framing tool, which can help guide ICS leaders through a process of understanding their social and economic value, reframing the questions they should be asking as they develop integrated care strategies, highlighting the partners, policies and funding programmes that can help realise their collective ambitions, and measuring the impact made.
  • There will be tensions between the short-term operational pressures leaders face and the long-term nature of social and economic development. We are particularly grateful to Cathy Elliott for researching and creating a maturity framework to complement this report, following engagement with fellow ICS leaders. The framework aims to support a system to gauge their progress and also design and agree delivery milestones in the coming years across a range of suggested example areas.
  • The external landscape in which an ICS is making decisions is rapidly changing, with significant social and economic churn. This report looks at the wider implications and opportunities that may arise as ICSs become more engaged in this purpose. In particular, there will be clear overlaps with areas developing new and existing devolution deals, as outlined in the levelling up white paper.
  • We believe with the right support, leadership and collaboration, ICSs can make significant progress in delivering against their purpose of supporting social and economic development. The role of NHS England is particularly important in developing ongoing packages of practical support, permissive frameworks for systems on policy and delivery, ensuring leadership programmes reflect the system-nature of this work and engaging across government.
  • Recognising the innovative and unique nature of this purpose, we also believe it offers opportunities for NHS England to evolve its future relationship with systems. In, for example, setting a collective expectation for the 42 ICSs to work together across thematic or geographic areas to come up with a joint plan on how they will fulfil this purpose, NHS England would be making ICSs accountable for both their progress and collaboration.


In this report we explore why social and economic development is now considered a central part of work in the health and care sector in England and how the newly established integrated care systems (ICSs) can deliver on their core purpose of helping the NHS to support it. To understand, embrace and enable this change, we have explored the what, the why, the how and the where next.

In doing so, we have:

  • described what we mean by social and economic development and the associated landscape into which ICSs have emerged as statutory partnerships in England (chapter 1)
  • reflected on the views of leaders and identified some of the perceived behaviours and cultures that need to be collectively challenged as NHS organisations learn to work as part of wider systems (chapter 2)
  • explained the need to move to a more strategic focus on multisector anchor systems to truly influence the lives and livelihoods of our given populations (chapter 3)
  • created a light touch four-step model framing that can support local systems to understand, shape and deliver on the ICS purpose of supporting social and economic development locally (chapter 4)
  • highlighted further support needed to accelerate this journey including an ICS maturity framework, the necessary skill set and examples of emerging practice (chapter 5)
  • crafted a set of recommendations for national bodies and for systems to consider (chapter 6).

ICB joint forward plans (JFPs) will need to describe how the ICB and its constituent NHS providers will support the development and delivery of local strategies to influence the social, environmental and economic factors that impact on health and wellbeing. Importantly, NHS England has not set specific recommendations or policy on the role of NHS
partners in supporting broader social and economic development, encouraging a permissive approach to local innovation and design.

With this in mind, NHS England commissioned the NHS Confederation to reach a common understanding of the NHS’s role as a partner within an ICS, through engagement with a wide range of system partners and drawing on the emerging work already happening. This helped us understand the appetite, the ambition, and the actions that they are undertaking as they begin to unlock the sector’s social and economic potential and learn more about its role.

Spread throughout this report are a number of leadership quotes from these roundtables, which help tell a story in themselves. While it is certainly not an overstatement to say that how an ICS and partners approach this particular purpose will determine the level of its local support and success more broadly, the overriding message was one of
positivity, collaboration and intent.

Finally, it is worth noting there are a plethora of guides already published for leaders to digest on a range of related subjects. This report is as much about inspiring and provoking as it is a plan to be rigidly followed. Central to supporting social and economic development, and thus delivering better outcomes for our populations, is a willingness to ask new questions, to be critical in our thinking and to unlock our collective imagination.

This agenda may be a long-standing and ever-present one for many, but as formal partnerships ICSs are at the start of their journey – we want to hear from you about your progress and how we can adapt and evolve the information, advice and support in this report to continuously stretch both our thinking.