Background to the report
Integrated Care Systems (ICSs) bring together NHS, local government and other partner organisations to plan and deliver integrated services to improve the health of the local population. There are 42 ICSs covering the whole of England, ranging in size from 542,000 people to 3.51 million. ICSs were introduced into legislation by the Health and Care Act 2022, the relevant provisions of which took effect from 1 July 2022.Jump to downloads
ICSs are the latest in a long line of restructures by the Department of Health & Social Care (DHSC) aimed at improving health outcomes and efficiency by joining up health, social care, and other services, as well as tackling inequalities in outcomes, experience and access, in addition to enhancing productivity and value for money.
Scope of this report
This report examines the setup of ICSs by DHSC, NHS England (NHSE), and their partners and the risks they must manage. Unlike many National Audit Office reports, this is not an assessment of whether the programme has secured good value for money to date because ICSs have only recently taken statutory form. Instead, it is an assessment of where they are starting from and the challenges and opportunities ahead. We make recommendations intended to help manage those risks and realise those opportunities.
This summary provides our key findings, our conclusion on ICSs’ likely success, and our recommendations. The rest of the report sets out:
- an introduction to ICSs, describing their structure, objectives, and governance arrangements (Part One);
- an overview of the positions that ICSs are starting from, in terms of finances, staffing and activity levels, and some of the wider challenges facing the health and care sector (Part Two); and
- an examination of government’s efforts to improve population health through better integration and a focus on prevention, and our assessment of ICSs’ prospects for success this time (Part Three). Introducing Integrated Care Systems: joining up local services to improve health outcomes
The introduction of Integrated Care Systems in July 2022 marks another significant reorganisation in the way health services are planned, paid for, and delivered. The statutory Integrated Care Boards and Integrated Care Partnerships that form these systems are broadly welcomed by local service leaders. The NHS Long Term Plan, published a year before the COVID-19 pandemic, sought to join-up local services and grant more local autonomy to design services and invest in prevention to improve people’s health and tackle the pressure on the NHS.
The COVID-19 pandemic has put health and care services at every level under enormous pressure, and significantly increased the backlog of people waiting for treatment, care or support. The health and care system now needs to address these immediate pressures alongside its longer-term objectives.
At present, the inherent tension between meeting national targets and addressing local needs, the challenging financial savings targets, the longstanding workforce issues and wider pressures on the system, particularly social care, mean that there is a high risk that ICSs will find it challenging to fulfil the high hopes many stakeholders have for them. To address these risks, DHSC and NHSE will as a first step need to clarify what a realistic set of medium-term objectives looks like under current circumstances, building on the work done on core NHS objectives to ensure ICSs can make progress on prevention and local priorities.
NHSE and DHSC also need to tackle those pressures on ICSs that require national-level strategies and solutions, including workforce shortages, NHS financial sustainability and pressures on social care. ICSs need the time and capacity to build relationships and work together to design services that better meet local needs. If DHSC, NHSE and partners can address these challenges, then ICSs could bring real improvements in the longstanding challenge of bringing health, social care and other services together with the ultimate aim of improving the health and well-being of the populations they serve.
- Report - Introducing Integrated Care Systems: joining up local services to improve health outcomes (.pdf — 1 MB)
- Summary - Introducing Integrated Care Systems: joining up local services to improve health outcomes (.pdf — 139 KB)
- ePub - Introducing Integrated Care Systems: joining up local services to improve health outcomes (.epub — 3 MB)
- ISBN: 978-1-78604-447-1 [Buy a hard copy of this report]
- HC: 655 2022-23
View press release (14 Oct 2022)