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Explained: ICSs and their role in the NHS

Explained: ICSs and their role in the NHS
By Léa Legraien Reporter
31 May 2018

Since the creation of the 44 Sustainability and Transformation Partnerships (STPs) in 2016, 10 have evolved into Integrated Care Systems (ICSs), including two devolved areas.

On 24 May, NHS Improvement and NHS England announced that another four STPs would become ICSs in 2018/19.

These include Gloucestershire STP, Suffolk and North East Essex STP, West, North and East Cumbria STP and West Yorkshire and Harrogate STP.

With NHS England and NHS Improvement aiming to help all STPs become ICSs, what progress has been made so far and what does it mean for the population?

What is an ICS?

An ICS brings together health and care organisations and local authorities to provide integrated services for a defined population and improve its health and care outcomes. It’s similar to an STP but with even closer collaboration.

At the moment, there are eight ICSs: Bedfordshire, Luton and Milton Keynes; Berkshire West; Blackpool and Fylde Coast (now Lancashire and South Cumbria); Buckinghamshire; Dorset; Frimley Health; Greater Nottingham and; South Yorkshire and Bassetlaw, plus two devolved health and care systems, Surrey Heartlands and Greater Manchester.

Why do we need ICSs? 

Rising demand within the NHS coupled with budget constraints over the past few years has pushed the service to look for different ways to meet people’s health and care needs.

Through ICSs, NHS England hopes to see sustainable improvements in health and care, work differently and tackle the recurrent challenges by:

  • Creating more robust cross-organisational arrangements
  • Supporting population health management approaches that facilitate the integration of services focused on populations at risk of acute illness and hospitalisation
  • Delivering more care through re-designed community and home-based services, including partnerships with the social care, voluntary and community sector
  • Allowing systems to take collective responsibility for financial and operational performance and health outcomes

What progress have we seen so far?

Early evidence suggests progress is being made in lowering demand for hospital care and emergency admissions, according to NHS England.

For example, Frimley Health saw fewer GP referrals and accident and emergency attendances, while in Berkshire West, care is now provided closer to home, wherever appropriate.

Some ICSs are beginning to take control of serious challenges, which would have previously been addressed through external intervention.

Greater Manchester, for instance, is taking ownership of its health and social care public funding. Last year, the new Northern Care Alliance NHS Group brought together more than 17,000 staff from Salford Royal NHS Foundation Trust and The Pennine Acute Hospitals NHS Trust.

With a joined budget of £1.3bn, the group stakeholders are working together to serve locally and joined health and care services for over one million patients.

What does the future hold for ICSs?

As ICSs are fairly new, it’s not yet clear what the future will look like. The King’s Fund chair Chris Ham believes that ICSs’ fate will depend on ‘the willingness of organisations and their leaders to commit to partnership working’.

He adds: […] ‘ICSs could be derailed if any of the partners decide to withdraw, even when national NHS bodies are making it clear that they see this way of working as being the future for the NHS.

‘The biggest risk to integrated care is organisational protectionism, rather than privatisation, linked to a history of competitive behaviour and sometimes poor relationships between the leaders who need to collaborate to make a reality of integrated care.’

Oxford Academic Health Science Network (AHSN) lead Dr Siân Rees argues that acronyms and organisations are likely to change over time and that what really matters to patients and the public are principles and processes.

National Association of Primary Care (NAPC) chair Dr Nav Chana adds: ‘Integrated care isn’t an end in itself but a means through which we [can] improve healthcare outcomes.’

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