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Integrated Care Systems still on track for 2021

The COVID crisis has impacted primary care and despite the pressures, NHS England is pressing ahead with its Long Term Plan and meeting the target of having Integrated Care Systems covering every area of the country by April 2021.

What is an 'Integrated Health System'? A Summary

The idea is that local communities can benefit from a stronger focus on prevention and tackling issues that impact health such as housing, unemployment, social inclusion to improve wellbeing and prevent health issues from overwhelming local primary care services.

  • A way of working that brings together the expertise of health and social care organisations, community groups and local charities to help people live well for longer.
  • Local health organisations – Hospital Trusts, GPs, Ambulance service, STPs, CCGs, PCNs etc – will work with local authorities and other bodies.
  • More emphasis on promoting wellness and preventing ill-health and making sure hospitals can provide specialist care and treatment.
  • Delivering care closer to where people live in their own homes and neighbourhoods. So they can get “the right care, at the right time, in the right place”.
  • Staff, residents, patients, community groups and local charities will all help shape where and how care will be delivered.

There are currently 18 areas covered by an ICS, which are currently classed as voluntary partnerships as they have no basis in legislation, no formal powers or accountabilities.

An ICS will cover a larger geographical area, using a model of “systems within systems” – smaller partnerships that will focus on the local populations but working together to cover the expected ICS coverage of 1 to 3 million people.

By April 2022, each ICS should have a workforce strategy that lines up with the requirements of the NHS People Plan. NHSE will provide the finances and ICS leaders will allocate their budgets as necessary between their different service providers in their areas.

Structure of Integrated Care Systems

As described in the NHS Long Term Plan, every ICS will have the following structure in place;

  • A partnership board, drawn from and representing commissioners, trusts, primary care networks, and (with the clear expectation that they will wish to participate) local authorities, the voluntary and community sector and other partners;
  • a non-executive chair (locally appointed, but subject to approval by NHS England and NHS Improvement) and arrangements for involving non-executive members of boards/ governing bodies;
  • sufficient clinical and management capacity drawn from across their constituent organisations to enable them to implement agreed system-wide changes;
  • full engagement with primary care, including through a named accountable Clinical Director of each primary care network;
  • a greater emphasis by the Care Quality Commission (CQC) on partnership working and system-wide quality in its regulatory activity, so that providers are held to account for what they are doing to improve quality across their local area;
  • all providers within an ICS will be required to contribute to ICS goals and performance, backed up by
    • potential new licence conditions (subject to  consultation) supporting NHS providers to take responsibility, with system partners, for wider objectives in relation to use of NHS resources and population health; and
    • longer-term NHS contracts with all providers, that include clear requirements to collaborate in support of system objectives;
  • clinical leadership aligned around ICSs to create clear accountability to the ICS. Cancer Alliances will be made coterminous with one or more ICS, as will Clinical Senates and other clinical advisory bodies. ICSs and Health and Wellbeing Boards will also work closely together.

NHS England has recently recommended that, in order to give more clarity and accommodate the transition, there should be legislation to abolish CCGs by April 2022 and revoke the section 75 competition regulations, allowing NHS services to be protected from competition rules and regulations, which reverses two of the major changes from the Health & Social Care Act 2012.

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