The bodies set up to redesign health and care services around the changing needs of the population are being held back from fully delivering improvements for their local communities because of under-investment in workforce and capital, and a lack of a social care workforce plan.
That’s according to a new report from NHS Confederation, ‘The state of integrated care systems 2022/23: Riding the storm’, which has sought the views of leaders across the country’s Integrated Care Systems (ICSs) in their first year as formal partnerships of health organisations, local authorities and other bodies.
In the survey, ICS leaders cited workforce pressures, issues with social care, and financial constraints as their main challenges, echoing the findings of reports by the National Audit Office and Public Accounts Committee which warned that ICSs would find it difficult to deliver on their long term aims unless these issues are tackled.
ICS leaders told the NHS Confederation that these challenges (and the disruption of industrial action in the last 12 months) make the task of balancing long-term transformation and short-term operational delivery significantly more difficult.
Sarah Walter, director of NHS Confederation’s ICS Network, says: “ICS leaders are proud of the progress they’ve made in really tough conditions, but they are deeply frustrated by some of the potentially soluble barriers that are hindering the extent to which they can get on with transforming services for their local communities. They want to see these tackled urgently if ICSs are to fulfil their full potential.
“Workforce pressure was cited as the biggest issue, closely followed by finances, with a call for the promised review of the entire NHS capital regime to progress without delay. ICBs are also concerned about having to reduce their running costs by 30% over the next two years, and the risk that this adds further pressure and absorbs management time and headspace in a context where the number of functions being delegated to ICSs continues to increase.
“A further barrier holding back the progression of ICSs is the government’s refusal to commit to a long-term workforce plan for social care.
“While it is encouraging that ICSs are recognised as the right model at the right time for health and care, more concerted action is needed to create the right conditions to help them succeed in delivering even better, more joined-up care for patients.”
The survey suggests that ICS leaders feel they have made good headway, with relationships and foundations forming, as well as some positive changes being made at a national level – including shorter and more focused operational planning guidance for the NHS and structural changes to NHS England (NHSE) – but are concerned that the asks of ICSs have grown while resources have been cut.
They are urging national bodies and the government to take a number of actions, so ICSs can effectively deliver for the populations they serve and reach their full potential.
To best support ICSs in year two of their existence as statutory bodies, leaders want to see:
• Social care workforce plan. The NHS Long Term Workforce plan was welcomed, but leaders want the government to develop an equivalent plan for the social care workforce to recognise the contribution and value of this sector.
• Capital spending review. NHS leaders support the government’s commitment to reviewing the entire NHS capital regime in response to the Hewitt review, but call for the amount of capital funding to be included in the review, as well as the complex allocation process.
• Support for new commissioning functions. NHSE should work closely with ICBs to ensure that they have access to the data and the capacity they need to effectively discharge their new commissioning functions.
• Devolve to evolve. As the Hewitt review and the Health and Social Care Select Committee proposed, DHSC and NHSE should focus on setting a small number of targets based on outcomes and give ICSs the freedom to innovate in how they deliver against these.
• Co-production. Through their response to the Hewitt review and new operating framework, DHSC and NHSE have committed to embedding a co-production approach. Co-production of policy and guidance impacting ICSs should become the norm. This should include, in particular, work on system accountability arrangements.
While leaders are clear on what needs to be done to support ICSs, they remain positive about the work they are doing, with nine in ten ICS leaders saying that partners within their local systems are working collaboratively to set and deliver on their key priorities. The same proportion also reported that their integrated care board (ICB) and integrated care partnership (ICP) are working well together.
They are also positive about the new functions ICBs have recently taken on, including the commissioning of community pharmacy, optometry and dentistry (POD) services.
As well as examining the progress that local systems have made, the report explores where leaders feel there are opportunities for further development, with devolved decision making a priority area.
The research found that ICS leaders remain committed to devolution to place-based partnerships and provider collaboratives as they mature. However, despite this commitment and intention, only 45% of survey respondents felt that their ICS currently devolves decisions to the most local level, as close to local communities as possible, but said that this was a priority for their next stage of development.
This report is based on a national survey which was open to Chief Executives and Chairs of ICBs and Chairs of ICPs between March 14 and April 25, 2023. A total of 47 responses were received, representing 36 of the 42 systems. The full report may be downloaded here.
