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There are too many integrated care systems (ICSs) in some parts of the country, especially the South West and Midlands, writes Alastair McLellan and Dave West in this HSJ article. This means that effective integration will struggle due to limited resources, leadership capacity and ability to influence large providers. It is also a problem widely acknowledged at the centre and within the regions.  The proposed structure for ICSs is overly complex, consisting of a partnership board with little statutory power, which is meant to give strategic direction to an executive board which in practice will be held accountable for all decisions, but which is also meant to give up as much power and money as possible to “place based” entities which remain ill defined and have no statutory standing.

Plans to establish integrated care systems (ICSs) as statutory bodies in the health and care bill foreshadow further changes to the organisation of the NHS. Unlike previous reorganisations, the changes expected to occur in 2022 have developed from within the NHS rather than being imposed by the government. Not only this, but leaders in the NHS have also played a major part in shaping the nature of these changes in partnership with the centre.  This paper from the NHS Confederation focuses on the changes needed to create the conditions in which ICSs can improve outcomes for patients and the public and outlines a series of simple rules to guide those leading the reform programme. The ideas put forward are intended to provide a basis for debate with healthcare leaders and others in England about next steps. The paper starts from the premise that a key role of leaders is to harness the intrinsic motivation of health and care staff and public health teams to perform to the best of their abilities. The distinctive contribution of ICSs is to work with partners in making use of all available assets and leading improvements in patient care and outcomes that require actions across the organisations and services that make up the health and care system. Staff must be fully engaged in this work as it is through their actions that patients and the public will experience improvements

This paper summarises how core NHSEI quality functions are expected to be delivered through Integrated Care Systems from April 2022. The functions covered are not exhaustive and the work is ongoing. This paper is a working draft which represents the current position, based on workshops and engagement with national policy teams, regional teams and systems.

This guidance provides further clarity to guide the development of quality governance arrangements in integrated care systems (ICSs), particularly System Quality Groups (SQGs), which all ICSs must have. It sets out the National Quality Board’s requirements for quality governance in ICSs. Provides model terms of reference for SQGs and place-based meetings. Outlines suggested relationships with the integrated care boards (ICBs) and local authority assurance in relation to wider quality governance. Provides advice on administrating SQGs, including conflicts of interest. Sets out key principles for the approach to risk management within SQGs. This will be supplemented by further NHS England and NHS Improvement guidance on risk response and escalation, due in early 2022.   See also the National Quality Board's Position Statement: Managing Risks and Improving Quality through Integrated Care Systems

Integrated care systems (ICSs) are geographically based partnerships that bring together providers and commissioners of NHS services with local authorities and other local partners to plan, co-ordinate and commission health and care services. They are part of a fundamental shift in the way the health and care system is organised – away from competition and organisational autonomy and towards collaboration, with health and care organisations working together to integrate services and improve population health. ICSs have been developing for several years – the Health and Care Bill will put them on a statutory footing from April 2022. 

This reflection published in the International Journal of Integrated Care provides a perspective on front-line involvement of a patient and caregiver in a research project focused on integrated care.