Accountability arrangements for ICSs need to drive behaviours that reinforce collaboration, not undermine it, according to a report from think tank The King’s Fund.
The report, called Realising the potential of integrated care systems, looked at ICS efforts to develop system-wide approaches to recruitment, training and retention of staff through 24 interviews with local leaders in four case study sites, and a series of online workshops.
It suggested that ICS success ‘depends on supporting people at all levels to think, plan and act in “system-focused” ways’ and called on policy makers to ensure that frameworks and behaviours used to hold ICSs to account are ‘proportionate and reinforce local partnership working’.
The report also called on politicians to ‘be realistic’ about the speed at which ICSs can bring about improvements and asked for greater flexibility to use national funding in ways that best serve local priorities.
It said: ‘Our research found that there is a risk of ICSs going ‘off track’ as a result of pressures on services, intense political scrutiny, and extremely difficult economic circumstances – and the effects these conditions are having on the behaviours of leaders locally, regionally and nationally.
‘Many interviewees argued that they would need more time and a period of stability before they would be able to fully realise the potential of ICSs to deliver innovative workforce solutions.’
It added: ‘Interviewees argued that [flexibility of funding] is likely to deliver greater impact from the resources available and would help to strengthen the local partnership working on which the success of ICSs depends.’
Chris Naylor, senior fellow at The King’s Fund and lead author of the report, said: ‘ICSs were born into a storm, but despite their rocky start, there are now signs of the benefits brought by more collaborative working through these structures. The new Secretary of State for Health and Social Care has committed to avoiding imposing further structural changes in the NHS, which means the challenge is to make sure ICSs now have the best possible chance of driving improvements for patients.
‘Central to this is avoiding the temptation to tie their hands with nationally dictated actions; instead, ICSs should be held to account for achieving outcomes while allowing them the freedom to achieve those outcomes in the most effective way for their area.
‘Much of the work that happens within ICSs goes unseen. We found that where system working is functioning well, changes have been underpinned by the efforts of local leaders to strengthen relationships between their organisations, change mindsets and culture to one of collaboration, and encourage different behaviour within their system.
‘Those working in health and care systems made clear that the government must return to the recommendations set out in the independent review of ICSs led by the Rt Hon Patricia Hewitt last year, such as shifting away from a culture of top-down performance management to one of learning and improvement.’
It comes as Lord Darzi is to lead a ‘state of the NHS’ investigation, results of which will be published in September.
