The state of integrated care systems 2022/23: Riding the storm (NHS Confederation, 17 August 2023)

Summary

The State of Integrated Care Systems 2022/23 examines the progress that local systems have made, and opportunities for further development.

The NHS Confederation’s ICS network collected the views of 47 integrated care board chairs and chief executives, and integrated care partnership chairs, in the spring, as well as holding roundtables.

The results found they are generally positive about relationships – with 88% agreeing that “partners within my ICS are working collaboratively”.

However, when asked about whether a range of organisations in their area “have the requisite level of resourcing and maturity to deliver the ambitions outlined in your integrated care strategy”, there were signs of concerns about primary care networks, provider collaboratives and place-based partnerships, all of which saw less than 50% of leaders agree.

Content

Key points

• As integrated care systems (ICSs) mark the first anniversary as formal partnerships, this report examines the progress that local systems have made, opportunities for further development and the areas where ICSs require action and commitment from national partners in order to ensure that they are able to effectively deliver for the population that they serve.
• The report shows that ICSs have got off to a strong start in a difficult operating environment – one that has been marked by one of the most challenging winters on record, rising demand for care, a cost-of-living crisis, ongoing industrial action, and reductions in the running costs of ICBs that materialised just seven months into their existence as statutory bodies.
• Nine in ten ICS leaders say that partners within their local systems are working collaboratively to set and deliver on their key priorities. Nine in ten ICS leaders also report that their ICB and ICP are working well together. ICS leaders do, however, highlight some of the challenges of partnership working and will look to build on this progress by strengthening collaboration and building capacity across all system partners.
• ICS leaders and their partner organisations are positive about the progress that local systems have made. These include coordinating the operational response to winter pressures, encompassing urgent and emergency care, discharge and elective recovery; developing and strengthening place-based arrangements and cross-system collaboratives; supporting and commissioning primary care; improving financial sustainability and productivity; enhancing engagement and co-production capabilities; and developing long-term, joint strategic plans.
• However, ICS leaders report a number of barriers that are impeding their progress and which require action from government and national bodies. The top three are: staff shortages and the lack of an equivalent long-term workforce plan for social care; a lack of funding for social care; and NHS finances, including unexpected cuts to ICB running costs and an ineffective capital regime.
• At the same time, ICBs have taken on greater responsibilities than when they went ‘live’, including the commissioning of primary pharmacy, optometry and dentistry services, and they have now been charged with implementing large elements of the NHS Long Term Workforce Plan. There is a clear danger that they are being asked to take on too much while their running costs are reduced by 30%. In particular, the further delegation of functions requires specialist capability which will now be in shorter supply.
• These barriers are compounded by a short-termist approach within government that is dragging ICSs into more immediate operational priorities over the long-term shift towards integration, equity and prevention that they have been tasked with delivering.
• While ICS leaders identify a number of areas where progress has been made, they also pinpoint areas where progress has been slower than hoped. These include their plans and commitment to supporting greater devolution. There are positive examples of devolved decision-making and provider collaboratives that ICSs will want to build on, but as place-based partnerships and provider collaboratives mature, ICS leaders recognise the need to devolve more decisions and functions to a more local level. That is their intention in the next period of their development.

On behalf of ICS leaders, and to best support ICSs in year two of their existence as formal partnerships, this report makes a number of recommendations to policymakers in government and national bodies:

1. Social care workforce plan: We welcome the NHS Long Term Workforce Plan and call on the government to demonstrate its commitment to supporting the social care sector by developing an equivalent plan for the social care workforce.
2. 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, which is resulting in delays in accessing funding that could be used to enhance productivity.
3. New commissioning functions: NHS England (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 and responsibilities.
4. Devolve to evolve: We encourage the government and NHSE to commit to their intention to set a small number of core targets based on outcomes and to give ICSs the autonomy to innovate in how they deliver against these targets.
5. Co-production: We support a shift whereby co-production of national policy and guidance with ICSs becomes the norm, reflecting the planned changes to NHS England’s operating model. This should help to ensure that the support provided through NHSE’s regional and national teams is aligned with what ICSs need.