Integrated Care Systems (ICSs)
Integrated care systems (ICSs) are geographically based partnerships that bring together providers and commissioners of NHS services with local authorities and other local partners to plan, co-ordinate and commission health and care services. They are part of a fundamental shift in the way the health and care system is organised – away from competition and organisational autonomy and towards collaboration, with health and care organisations working together to integrate services and improve population health.
This diagram and accompanying narrative are based on the provisions in the Health and Care Act.
Interpreting the diagram
The diagram uses the framework of system, place and neighbourhood to explain how organisations will contribute to system working at these different levels. Many organisations will work across more than one level, while there will be a variation in ways of working between ICSs given their different sizes and how they have developed. This flexibility is an important feature of ensuring ICSs can work effectively to meet local needs.
The statutory ICS will be made up of two key bodies – an integrated care board (ICB) and integrted care partnership (ICP).
Integrated care board (ICBs) will take on the NHS planning functions previoulsy held by clinical commissioning groups (CCGs) and are likely to absorb some planning roles from NHS England. ICBs will have their own leadership teams, which will include a chair and chief executive, and will also include members from NHS Trusts / Foundation Trusts, local authorities, and general practice, selected from nominations made by each set of organisations, and an individual with expertise and knowledge of mental illness. In consultation with local partners, the ICB will produce a five-year plan (updated annually) for how NHS services will be delivered to meet local needs. In developing this plan and carrying out their work, the ICB must have regard to their partner ICPs integrated care strategy and be informed by the joint health and wellbeing strategies published by the health and wellbeing boards in their area. Additionally, each ICB must outline how it will ensure public involvement and consultation.
ICBs will also contract with providers to deliver NHS services and will be able to delegate some funding to place level to support joint planning of some NHS and council-led services.
Integrated Care Partnerships
Integrated care partnerships (ICPs) will operate as a statutory committee, bringing together the NHS and local authorities as equal partners to focus more widely on health, public health and social care. ICPs will include representatives from the ICB, the local authorities within their area and other partners such as NHS providers, public health, social care, housing services, and voluntary, community and social enterprise (VCSE) organisations. They will be responsible for developing an integrated care strategy, which sets out how the wider health needs of the local population will be met. This should be informed by any relevant joint strategic needs assessments (see below). In developing its integrated care strategy, the ICP must involve the local Healthwatch, the VSCE sector, and people and communities living in the area. ICPs will not directly commission services.
Partnership and delivery structures
A number of partnership and delivery structures will operate within an ICS at system, place and neighbourhood level.
NHS providers will work together at scale through provider collaboratives, new partnerships operating across ICSs to improve services. Provider collaboratives, which may involve voluntary and independent sector providers where appropriate, are expected to be operating across England by July 2022 and will agree delivery objectives with partner ICSs.
Health and wellbeing boards (HWBs) are formal committees of local authorities that bring together a range of local health and care partners to promote integration. They are responsible for producing a joint strategic needs assessment and a joint health and wellbeing strategy for their local population.
Place-based partnerships operate on a smaller footprint within an ICS, often that of a local authority. They are where much of the heavy lifting of integration will take place through multi-agency partnerships involving the NHS, local authorities, the VCSE sector and local communities themselves.
Primary care networks (PCNs) bring together general practice and other primary care services, such as community pharmacy, to work at scale and provide a wider range of services at neighbourhood level.
The NHS organisations within ICSs, including ICBs, NHS trusts and foundation trusts, will be accountable to NHS England for their operational and financial performance. The Care Quality Commission (CQC) will independently review and rate the quality of partnership working within ICSs, alongside its existing responsibilities for regulating and inspecting health and care services.
To find out more about integrated care systems and how they work under the health and care act, please visit here: The Kings Fund