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.
Please use this page to navigate to the various section of the report. The Executive Summary and Bibliography can be found below. You can locate a full pdf version of the report here.
Executive Summary
Integrated Care Systems (ICSs) are the latest initiative to plan and deliver joined-up health and care services and improve the quality of life for individuals who live within their designated areas.
On 1 July 2022, 42 ICSs were formed across England, with the statutory powers of Clinical Commissioning Groups (CCGs) being transferred to the Integrated Care Boards (ICBs) and the statutory ascendancy of the Integrated Care Partnerships (ICPs) coming online. The function of an ICS is to deliver four core objectives:
• Improve outcomes in population health and healthcare
• Tackle inequalities in outcomes, experience, and access
• Enhance productivity and value for money
• Help the NHS support broader social and economic development.
As we approach the end of the first year since their inception, Care England looked to understand how these ICSs sought to establish themselves, particularly through the lens of the adult social care sector, and the progress made in integrating their local health and social care system. The core focus of this report is to identify: what is working well, why it’s working well, and how we can accelerate the implementation of integrated care which recognises the value of the adult social care sector.
To inform this report, Care England conducted a series of qualitative interviews with ICS leaders from across England to understand how their system has developed over
this period. The report aims to improve the national understanding of how systems have managed the transition from CCGs to ICSs and how they have addressed systemic barriers to delivering on their four core objectives. To achieve this, the report addresses four topics:
• New structures and managing the change
• Identifying and overcoming the pressure points
• The priorities and ambitions
• Where do we go next?
The report provides a summary of the key discussions and concludes with a set of tangible recommendations that seek to further accelerate the integration between health and social care, whilst overcoming barriers.
Recommendations
New structures and managing the change
• 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 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.
The priorities and ambitions
• 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?
• 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.
Bibliography
• Care Quality Commission (2022). The state of health care and adult social care in England 2021/22.
• Department of Health and Social Care (2022). ‘Joining up care for people, places and populations. The government’s proposals for health and care integration.’ Open Government License.
• Dixon-Woods, M. (2011). ‘Using framework-based synthesis for conducting reviews of qualitative studies.’ BMC Medicine. 9:39.
• Flick, U. (2008). Designing Qualitative Research. London: SAGE Publishing.
• Galdas, P. (2017). ‘Revisiting bias in qualitative research: Reflections on its relationship with funding and impact.’ International Journal of Qualitative Methods. 16: 1–2.
• Gale, N., Heath, G., Cameron, E., Rashid, S., and Redwood, S. (2013). ‘Using the framework method for the analysis of qualitative data in multi-disciplinary health research.’ BMC Medical Research Methodology. 13: 117–124.
• Hammarberg, K. and de Lacy, S. (2016). ‘Qualitative research methods: when to use them and how to judge them.’ Human Reproduction. 31(3): 498–501
• Novick, G. (2008). ‘Is there a bias against telephone interviews in qualitative research?’ Research in Nursing and Health. 31: 391- 398.
• Ritchie, J. and Spencer, L. (1994). ‘Qualitative data analysis for applied policy research’. In: Bryman, A. and Burgess, R. (eds). Analysing qualitative data. London: Routledge.
• Roulston, K. (2010). Reflective Interviewing: A Guide to Theory and Practice. Los Angeles, California: SAGE.
• Weiss, R. (1995). Learning from Strangers: The Art and Method of Qualitative Interview Studies. New York: The Free Press.
• World Health Organization (2016). Framework on integrated, people-centred health services. [Google Scholar].
• Knight, A. and Burdett, T., 2021. Achieving integrated care: the need for digital empowerment. Perspectives in Public Health, 141(1), pp.15-16.
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