A Summary of Integrating Care - Next Steps to Building Strong and Effective ICSs across England

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4 min read
Written by
Curtis Batterbee

Full ICS coverage of England by the end of 2020/21

In late November 2020, NHS England and NHS Improvement published their expectation that all parts of the health and care system in England would work together in ICSs by April 2021, in Integrating care: Next steps to building strong and effective integrated care systems across England.

The report (summarised here), sets out hopes to build on the NHS Long Term Plan, seeking to ‘lock in’ gains made by the most successful approaches to the pandemic response, including:

  • pathways rapidly developed across providers
  • joined-up support for vulnerable people
  • open data sharing
  • agile decision-making.

The report also seeks, by driving ICS development, to reduce the levels of hierarchy within systems and in doing so, minimise bureaucracy.


NHS England and NHS Improvement have set out eight key next steps in the development process in their rollout of system working:

1. Provider collaboratives

Provider trusts will be expected to form provider collaboratives, to join up services within places and between places.

2. Place-based partnerships

Systems will need to ensure effective place-based partnerships through:

  • full involvement of all partners who contribute to the place’s health and care
  • an important role for local councils
  • a leading role for clinical primary care leaders through Primary Care Networks (PCNs)
  • a clear strategic relationship with health and wellbeing boards
  • appropriate resources, autonomy and decision-making capabilities

to deliver four main roles:

  • developing PCNs
  • joining up health and care
  • understanding and organising proactive support for people and families at risk of being left behind
  • preventing future health risks.

3. Clinical and professional leadership

ICSs should embed system-wide clinical and professional leadership through their partnership board and other governance arrangements, including PCN representation.

4. Governance and accountability

Underpin partnership working arrangements with mutually-agreed governance, clear decision-making processes and transparent information sharing. Each system should define:

  • ‘place’ leadership arrangements
  • provider collaborative leadership
  • individual organisation accountability within the system

5. Financial framework

ICSs will be key bodies for financial accountability. Current CCG commissioning budgets, primary care budgets, specialised commissioning spend, central support or sustainability funding and nationally-held transformation funding will be held in a single ‘pot’.

ICS leaders will have a duty to distribute these resources in line with national rules and locally-agreed strategies, to protect the future sustainability of local services.

6. Data and digital

To fulfil the potential of digital and data to improve patient outcomes and drive collaborative working, systems will need to:

  • build smart digital and data foundations
  • connect health and care services
  • use digital and data to transform care
  • put patients at the centre of their own care

7. Regulation and oversight

Systems are expected to adopt more system- and place-level measurements, which might include reporting some performance data such as patient treatment lists at system level. Next year, new metrics will be used to support this, including an ‘integration index’ for use by all systems.

8. How commissioning will change

  • A single, system-wide approach to strategic commissioning
  • Service transformation and pathway redesign – provider organisations become a principal engine of transformation through place-based partnerships and provider collaborations.
  • Analytical resources should now be applied to better understanding how best to use resources to improve outcomes, rather than managing contract performance between organisations.

The expectation is that all systems will be ready to operate as ICSs from April 2021 and agree plans that identify:

  • By April 2021: how they continue to meet the current consistent operating arrangements for ICSs and further planning requirements for the next phase of the COVID-19 response
  • By September 2021: implementation plans for their future roles as outlined above, that will need to adapt to take into account legislative developments.

Legislative proposals

There are two possible options for legislating ICSs:

Option 1: a statutory committee model with an Accountable Officer that binds together current statutory organizations.

Option 2: a statutory corporate NHS body model that additionally brings CCG statutory functions into the ICS.

Both models share:

  • broad membership and joint decision-making
  • responsibility for owning and driving the system plan
  • operating in accordance with the triple aim duty
  • a lead role in relating to the centre
  • a basis for planning and shaping services across healthcare, social care, prevention and the wider determinants of health

NHSE have shown a clear preference of Option 2, for the perceived benefits of:

  • greater long-term clarity in terms of system leadership and accountability
  • a clearer statutory vehicle for deepening integration across health and local government over time
  • enhanced flexibility for systems to decide who and how best to deliver services.


Whichever option systems choose, it’s anticipated that this closer collaboration will be an effective mechanism for:

  • transformation against long-term population health priorities
  • driving sustainable performance on quality, access, finance and delivery of outcomes.

And that system partners will be able to take more effective action on:

  • managing acute healthcare performance challenges
  • using collective resource towards clear priorities through provider collaboratives
  • unwarranted variation
  • understanding capacity utilization across provider collaboratives
  • equity of access
  • equalizing pressures across system organizations.

While there will be some complexities, not least trying to agree significant governance changes during a pandemic, the push towards integrated working has the potential to be a big step in maximizing the existing resources of all health systems across England.

If you would like advice or support for your system on its integration journey, whatever stage you’re at, get in touch at info@ccal.co.uk

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