It seems like many years since the Government last proposed structural changes to the health and social care system, but all that is about to change. Amidst the privatisation controversy that accompanied the first and second readings of the Health and Social Bill earlier this month, it is easy to overlook some of the more ‘minor’ proposals that the Bill contains, including giving statutory force to some healthcare structures and organisations that have been flying quietly under the radar for some time. If you haven’t come across them already, please welcome the (fairly) new organisational kid on the NHS block: Integrated Care Systems, or ICS.
In February 2021, the Department of Health and Social Care (DHSC) published its policy paper ‘Integration and innovation: working together to improve health and social care for all’. The paper set out Government proposals for a Health and Care Bill which would remove the structural barriers that prevent health systems from being truly integrated, use legislation to eliminate transactional bureaucracy that “has made sensible decision-making harder”, and increase the accountability of NHS England both to government and to the taxpayer.
Health and social care integration at multiple organisational levels - and the benefits it can realise in terms of partnership working and joined-up, seamless care - is not a new idea by any means, but its practical implementation has so far failed to keep up with the political rhetoric. Moreover, this Government has been repeatedly criticised for its lack of a clear policy on social care. There has long been a need for a model of care that moves away from treating episodes of acute illness in hospital to meet the needs of increasing numbers of people living with chronic conditions in different care settings. According to the Government, the COVID-19 pandemic has only reinforced the need for further integration, collaboration and partnership.
As the King’s Fund explains, Integrated Care Systems (ICSs) are partnerships that bring together providers and commissioners of NHS services across a geographical area with local authorities and other local partners to collectively plan health and care services to meet the needs of their population. Their core aim is to integrate care across different organisations and settings, joining up hospital and community-based services, physical and mental health, and health and social care.
Since April 2021, England has formally been divided into 42 ICSs by geographic area, although some ICSs have been operating de facto since 2018, while others have evolved from Sustainability and Transformation Partnerships (STPs). Currently, however, ICSs have no statutory or legal force, formal powers or accountabilities. What is different now, therefore, is the use of legislation to impose a statutory duty on NHS organisations to integrate.
Under the provisions of the draft Bill, there will be a statutory requirement in integrate in two ways: (i) internal integration, so that internal boundaries to collaboration are removed and ‘working together’ becomes an ‘organising principle’, and (ii) greater collaboration between the NHS and local government, as well as wider delivery partners – or external integration.
The primary vehicle for effecting integration will be the newly-named Integrated Care Partnerships (ICPs) of NHS, local government and other partners operating over a geographical area similar, if not coterminous to, the ICS to “bring together systems to support integration and develop a plan to address the systems’ health, public health, and social care needs.” An Integrated Care Board will be responsible for and maintain oversight of the day to day running of ICPs.
Existing NHS Clinical Commissioning Groups (CCGs) will be abolished; their functions and most of their staff are expected to transfer to the Integrated Care Board.
As public affairs and lobbying professionals, the abolition of CCGs is unlikely to have a large impact on stakeholder relations provided, as intended, most staff transfer across to the new body. Even so, there is bound to be an element of transition as staff acclimatise to the new structures, which could adversely impact on their willingness or ability to engage or continue with existing campaigns.
Potentially more problematic for healthcare communicators is the fact that, to date, ICS have evolved and developed as each one sees fit; the exact nature of each ICS very much remains a work in progress, with some agreeing a strategic direction for local health and care services, while others have put in place infrastructure and ways of working to support collaborative working. Is ICP just a name change, or is there something substantively different about the terms of reference, strategic direction and powers of ICPs vs. ICSs? The Government has said that the new legislation “will aim to avoid a one-size-fits-all approach but enable flexibility for local areas to determine the best system arrangements for them”, albeit within a broad national, statutory framework. Likewise, public affairs professionals will need to adopt a bespoke approach to campaigning and lobbying activities, bearing in mind the specific priorities, agenda and composition of each ICP and the geographic health economy it represents.
As always, the devil will be in the detail. It will be interesting to see how much, if any, focus is devoted to this particular aspect of NHS and social care reform as the Bill progresses through its various stages over the course of the next few months.
Dave McCullough is Managing Director of Riverside Communications