NHS ICSs – What are they?

In January 2019, the NHS laid out its ‘long-term plan’. This document sets out a strategy for the development, modernisation, and growth of the NHS.

A crucial aspect of this plan is the implementation of Integrated Care Systems (ICSs). So, what exactly is an ICS, why are they being implemented, how are they being implemented, and what effect will they have on the way the NHS interacts with service providers?

What is an ICS?

An Integrated Care System is a partnership between NHS organisations, local councils, and other relevant bodies arranged to take collective responsibility for managing resources, delivering care, and improving the health of the population they serve.

They are the latest in a long line of initiatives aimed at integrating care provisions across local areas. ICSs are the evolution of Sustainability and Transformation Partnerships, or STPs, formed in 2016.

Their implementation marks the end of a decades long period where the focus has been on regional and organisational autonomy and the separation of commissioners and providers.

An ICS is broken down into 3 levels:

• System –

This is the level of the ICS itself. They cover populations of roughly 1-3 million people, and set overarching strategy, manage collective resources, and identify and share best practices to help reduce unwarranted variations in the delivery of care. ICSs lead changes that benefit from big picture planning, such as digital strategies, estate management, and workforce transformation.

• Place –

A place is defined as a town or district within an ICS, often coterminous with a council or borough. They typically encompass a population of around 250–500,000 people, and are the level where the majority of clinical services will be designed and delivered. Places are also the level where health management will be used to target interventions to particular groups.

• Neighbourhood –

Neighbourhoods are the smallest denomination within an ICS and include a population of roughly 30-50,000. This level is where groups of GPs and community-based services work cooperatively to deliver coordinated and proactive care and support.

Why are they being implemented?

January 2019 saw the NHS release their ‘long-term plan’, as the name suggests, providing a road map for the future of the Service. It includes an extensive list of performance targets and KPIs for the NHS as a whole, but is governed by 3 main objectives:

• Making sure that everyone gets the best start in life
• Delivering world-class care for major health problems
• Supporting people to age well

They intend to implement this strategy by:

In line with this long-term plan, ICSs are viewed as the means to achieve these aims. They allow organisations to work together and coordinate services more closely to make real improvements to people’s lives.

Staff benefit from improved cooperation and the ability to work more closely with colleagues from other organisations. Finally, systems of care are better able to understand data about local people’s health and therefore provide care that’s tailored to individual needs.

The NHS was initially founded in 1948 under Attlee’s Labour government to provide episodic care for acute health conditions. Now, with an aging population, the focus of healthcare is shifting towards more long-term provisions, and often within people’s own homes, removing some of the traditional borders of service.

ICSs are being formed at a time when increases in life expectancy are faltering and issues of health inequalities are rising. These systems have the potential to drive improvements in population health by taking a more holistic approach to healthcare, considering the wider determinants of health and involving a broader range of agencies.

How are ICSs being implemented?

Initially, it was intended that all parts of the NHS would have been integrated by April 2021. However, despite the benefits, there is no legal basis or requirement to develop ICSs by this time, and the issue has taken a backseat as the NHS works in overdrive to cope with the COVID-19 crisis.

There is no set blueprint for the development of an ICS, it’s intended to be a locally-led process, accommodating for differences in population sizes and needs. This permissive and flexible approach differs notably from previous centrally-driven reforms made to the NHS.

So far, the systems that are the furthest ahead are those that have prioritised the strengthening of collaborative relationships and trust between vital partner organisations and their leaders.

However, there is growing guidance from national NHS bodies surrounding the form and function of ICSs, drawing on experience from the first systems. The long-term plan set out a few initial expectations for ICSs, such as the requirement to establish a partnership board, involving organisations from across the system, and to appoint an independent chair.

NHS planning and guidance has more recently highlighted two key functions for integrated care systems:

• Co-ordination of system transformation
• Collective management of system performance

Does this change the relationship between service providers and the NHS?

In a word? Yes. The overriding theme here is cooperation and coordination, and the same is beginning to be expected of service providers. They are being encouraged to work increasingly with other providers, including from outside of the NHS, to plan and manage the transformation of services.

In the most advanced instances, the line between provider and purchaser has become increasingly blurred, and providers have been appointed to senior roles within local healthcare and at a CCG level. These service providers are then able to apply expertise to form joined care pathways and improve services.

Reflecting this, payment models are shifting away from activity-based models, and towards payments for acute services, favouring block or aligned-incentive contracts.

At Word360, we provide turnkey language services to the NHS on a national basis that support and benefit the ICS delivery model, adding value over time. We support wider initiatives such as Equality and Diversity and add social value through our CSR programme