This study seeks to investigate how Integrated Care Systems have developed since July 2022, with a specific focus on how they have managed and overcome pressures associated with the planning, coordination and commissioning of health and care services. Understanding these systems and their key pressure points will allow wider system partners to steer improvement across regions through best practices and partnerships across both short and long-term pressures.
The Findings and Discussions can be found below. You can locate a full pdf version of the report here.
While the individual experiences of integration over the last year are unique to each ICS, throughout the scope of this report and the interviews conducted to inform this project, each ICS reported similar overarching challenges and identified similar needs to be met to overcome them.
We have outlined recommendations that should be considered by the Government, NHS England, and ICS leaders to implement and establish meaningful integration with the adult social care sector.
New structures and managing the change
With the introduction of ICSs and the strong desire from ICS leaders to facilitate meaningful and positive change, there was recognition that there must be significant reformation to the governance structures. ICS leaders acknowledged the importance of hearing the voice of the sector at all levels within their system. Whilst local authority representation is welcome across ICBs and ICPs, local authorities do not speak for the care sector. There is clear value in having direct care provider or representative body involvement at the ICP and ICB levels.
- ICS leaders should seek to include an adult social care representative (either a care provider, a Care Association, or a representative body) on the ICP or the ICB to represent the views of adult social care providers. ICSs must take pragmatic steps to build appropriate, additional and transparent vehicles that feed directly to the ICP or ICB, to enable all elements of the care sector to provide valuable insight at a strategic level to aid decisions that work across their local health and social care sectors.
Identifying and overcoming the pressure points
The ambition of establishing a fully integrated health and social care system in isolation is incredibly significant. The Government’s demand for ICSs to reduce their operating costs by 30% has only hindered ICS leaders’ ability to realise this ambition. This first year was recognised by ICS leaders as a transitionary, foundational year to focus on establishing the baseline which subsequent years will build on. This Government’s requirement to reduce operating costs by 30% has forced systems to reprioritise previously foreseen targets and comes at a time when financial challenges are being cited as one of the key factors impeding success for these systems. With system partners recovering from severe Winter Pressures, the Covid-19 pandemic, and the health and social care sector suffering from chronic Government underfunding, ICS leaders noted that they must look at addressing short-term pressure points, which delays achieving their long-term goals.
- The Government should legislate ringfenced national funding for ICSs across multiple years to enable systems to plan, build, and execute long-term plans effectively to support a sustainable health and social care sector.
- The Government should look to adopt a consistent investment basis for ICSs wherein systems are given greater autonomy on how funding should be used to sustain health and social care. Locally.
The priorities and ambitions
To further the integration agenda, ICS leaders identified that they must prioritise cultural reform to build trust among partners and a more cohesive system that integrates health and care partners. To achieve this multi-faceted priority, ICS leaders need to analyse their care market in-depth and understand their role and capabilities within the system. ICS leaders expressed the ambition to integrate services and pull down existing barriers to pool their budgets, services, and teams to improve individual outcomes. For nearly all the ICS leaders interviewed, this priority was dependent on addressing the social care workforce crisis, which included issues around pay, recruitment, and retention. It was highlighted how digital transformation could help ease the pressure of workforce challenges and should be utilised further.
Data was recognised as a tool to provide crucial information that would improve the quality and delivery of care. Wider digital transformation was perceived as a vessel that would unlock new ways for systems to work together and create more streamlined approaches to developing new models of care. Whilst steps are being taken to accelerate the progress of digitally transforming the health and social care sector, it was recognised by ICSs that systems are at different stages of their digital journey.
- ICSs should undertake an exercise to gain a complete understanding of their adult social care sector market to ensure they are properly addressing needs and effectively utilising the strengths that exist within the system. The market assessment should be overseen by the Department of Health and Social Care and NHS England, who should be empowered to hold ICSs to account to ensure systems are taking appropriate measures to build a comprehensive knowledge base of their local health and social care market under the scrutiny of the Care Quality Commission.
- The Government should develop a national, long-term ‘Adult Social Care Workforce Strategy’, which includes and proposes solutions to improving workforce pay. This should be adopted by ICSs for their locality, characterised by a variety of different methods to support the recruitment and retention of the workforce. The strategy should encompass measures for success, with a comprehensive understanding of what such success looks like, to ensure ICSs are meeting workforce targets appropriately within their regions.
- NHS England should strive to ensure national oversight of each ICSs’ digital make up to ascertain where funding must be allocated to create a standardised consistent digital foundation that ICSs can build. This would include interoperable data systems that integrate with both health and social care IT systems.
Where do we go next?
There is a clear recognition by all ICS leaders that external support can promote greater shared learning, accountability, and collaboration between health and care through stronger representative support. Such tools will be instrumental in the years to come as ICSs further the integration agenda. They also provide ample opportunity for the development of localised approaches within their systems. Sharing knowledge, best practices and successful case studies can generate shared commonality between systems. Whilst platforms, such as NHS Futures exist, they can be difficult to navigate and are perceived as an NHS platform, not a health and social care system platform.
The increased representation of representative bodies and engagement with external organisations outside the healthcare sector can act as conduits for good practice at an individual, local or national level, by providing crucial insight into sector knowledge that an ICS may not have access to. Finally, representative organisations can increase accountability measures within an ICS, to ensure that the direction of travel meets the needs of all sector partners.
- Regional and national shared learning platforms must be developed for adult social care, NHS England, and system leaders to promote, ascertain, and develop shared learning, to improve the efficiency and effectiveness of integrated systems. These platforms must not be designed to exclude or diminish non-NHS system partners.
- ICSs should look to consult with representative bodies on strategic decisions for feedback and information to ensure that developed policies and ambitions set by the system reflect underrepresented areas within their ICS.
As ICSs progress into their second year, many of the challenges they face remain the same as they did upon inception over 365 days ago. Despite this, there are plenty of examples of innovative initiatives and positive steps towards a truly integrated health and social care system. This report should be viewed as a guide to help ICS leaders across England address integration challenges and enhance successes. Care England will continue to promote best practices and work with ICSs across the country to ensure meaningful integration proceeds and thrives.