Integrated Care Systems: benefits and challenges

With the pandemic highlighting the importance of the Health Service and Local Authorities working together, and indeed accelerating this collaboration, Health Business examines the collective responsibilities of Integrated Care Systems and how they can help reduce the burden on an overstretched NHS

Following many years of locally led development, pilots and recommendations from NHS England, on 1st July, 42 Integrated Care Systems (ICS) were established across England on a statutory basis, with both the NHS Long Term Plan and more recently, the government’s Health and Care Bill placing them at the heart of the NHS.

What is an ICS?
ICSs were created with the purpose of bringing together partner organisations to plan and deliver joined-up health and care services. The aims of ICSs include improving outcomes in population health and healthcare; tackling inequalities in outcomes experience and access; enhancing productivity and value for money; and helping the NHS support broader social and economic development.
Other goals include improving the health of children and young people; supporting people to stay well and independent; acting sooner to help those with preventable conditions; supporting those with long-term conditions or mental health issues; and caring for those with multiple needs as populations age.

Those involved in ICSs include an Integrated Care Partnership (ICP); an Integrated Care Board (ICB); local authorities, including those responsible for social care and public health functions; place-based partnerships; and provider collaboratives.

An ICP is a statutory committee formed between the NHS integrated care board and all upper-tier local authorities in that ICS’s area. The ICP is responsible for producing an integrated care strategy
An ICB is a statutory NHS organisation with the responsibility of developing a plan for meeting the health needs of the local population, managing the NHS budget and arranging for the provision of health services in the ICS area. Note, Clinical Commissioning Groups have been shut down as a result of the establishment of ICBs.
Place-based partnerships include the NHS, local councils, community and voluntary organisations, local residents, service users and those who support and care for service users. Place-based partnerships lead the detailed design and delivery of integrated services across each ICS.
Provider collaboratives bring together providers with the aim of working at scale across multiple places and one or more ICSs.

Potential benefits
While ICSs are currently in their infancy, their benefits are clear.
Providing joined-up care will mean a more seamless healthcare journey for patients, as clinicians will already have access to their healthcare records and information about their condition. This means patients will only have to explain their conditions and answer questions once instead of repeating themselves to each healthcare professional they come across. This should improve the patient’s journey through the care system, making it faster, more seamless and less stressful.
Providing holistic care will be a benefit to patients, so treatment for different health conditions is not isolated. The overall health of the patient will be considered when being treated, rather than the patient seeing one person for one health problem and then seeing another unrelated professional for another health problem.
The localisation of ICSs provides the ability to produce local solutions to local problems. For example, if a local area has a high rate of smoking, or a large elderly population, the ICS can work together to combat the problems and challenges that are associated with these populations and direct funding and resources towards these areas.
Increased sharing of data, information, and best practice means organisations will be able to improve the way they work and share lessons learnt and how best to tackle a challenge or treat a health problem. This should lead to improved healthcare.
Following on from this, sharing data and identifying localised health problems means organisations and authorities have the ability to prevent health problems before they get worse. For example, if an area is seeing a high number of patients presenting with alcohol-related problems, they can look at ways of reducing the consumption of alcohol in the local community. Identifying demographic trends in areas such as housing and unemployment can help identify those at risk of certain health conditions and give them contact with the health service before the problem worsens.
Joined-up healthcare and cooperation between primary and secondary care means patients should be directed to the right organisation or professional more quickly. This should help reduce pressure at both ends of the scale on GPs and on A&E departments, with fewer people going to their GP for ongoing conditions and fewer people going to A&E when they don’t know where else to go. This should reduce unnecessary consultations right across the health service and free up time and resources.
All of the above-mentioned should reduce pressure on NHS workload and finances, as well as improving patient experience.

While there are several benefits of ICSs, they will face some challenges. First of all, their introduction is a massive change - not everyone likes change and it takes some getting used to. Implementing any change on this scale would be a huge challenge in itself, but whilst the NHS and its staff are under an unprecedented amount of pressure, from Covid, backlogs, staff retention issues and much more, it will be even more difficult.
Staff must be encouraged to accept the changes and supported to implement them. NHS and social care workers need to be willing to work with and trust others who they may not have worked with before.
Finally, different ICSs in different areas will face varying pressures and workloads. Areas with high numbers of young working professionals have different workloads to areas with high unemployment.  Areas with large elderly populations will face different challenges to areas with large student populations and so on. There is a concern that ICSs in areas with populations with more health problems will be under more strain than those with healthier populations, and these areas will need the funding and support to deal with this.
Despite the challenges they face and their infancy, against a backdrop of unprecedented NHS pressures, the introduction of ICSs will help reduce the burden on the NHS with more targeted and holistic care for patients. Overall, this should reduce strain on NHS staff, resources and finances and improve the patient experience.