Moving to Integrated Care Systems: what does the NHS Long Term Plan say?

ICSs are central to the delivery of the NHS LTP and its ambition to deliver fully integrated community based healthcare services – marking a shift away from hospital based care. They will be responsible for delivering the ‘triple integration’ of primary care, secondary care and social care. And supporting the integration will be an additional £4.5 billion funding by 2023/24, designed to address demand pressures, workforce expansion and new services.

By April 2021, ICSs will cover the whole of England growing out of the current network of 44 Sustainability and Transformation Partnerships. With an increased focus on population health, ICSs will have a key role in working with local authorities at “place” level and through ICSs, “commissioners will make shared decisions with providers on how to use resources, design services and improve population health (other than for a limited number of decisions that commissioners will need to continue to make independently, for example in relation to procurement and contract award)”.

Every ICS will need streamlined commissioning arrangements to enable a single set of commissioning decisions at system level. Typically, each ICS area will work with a single CCG. The implication is that “CCGs will become leaner, more strategic organisations that support providers” on population health, service redesign and Long Term Plan implementation.

Every ICS will have

• Engagement with primary care, including through a named accountable Clinical Director of each primary care network.
• A partnership board representing commissioners, trusts, primary care networks, and local authorities, the voluntary and community sector.
• A non-executive chair.
• Sufficient clinical and management capacity to enable them to implement changes.
• A greater emphasis by the Care Quality Commission to focus on partnership working in its regulatory activity.
• All providers within an ICS will be required to contribute to ICS goals and performance, backed up by (a) potential new licence conditions and (b) longer-term NHS contracts with all providers.
• Clinical leadership aligned around ICSs to create clear accountability to the ICS.

Other commitments in the plan to support ICSs

• NHS Improvement will take a more proactive role in supporting collaborative approaches between trusts.
• Funding flows and contract reform will support the move to ICSs. Reference is made to the new Integrated Care Provider contract which will be made available for use from 2019 following the consultation. This will allow for the first time the contractual integration of primary medical services with other services, and creates greater flexibility to achieve full integration of care – the expectation is that ICP contracts would be held by public statutory providers.
• A new ICS accountability and performance framework, including a new ‘integration index’.
• ICSs will agree system-wide objectives with NHS England/NHS Improvement regional director.
• Support local approaches to blending health and social care budgets where councils and CCGs agree this. The Government will set out proposals for social care and health integration in the forthcoming Green Paper on adult social care.
• The Better Care Fund requires review as the funding mechanism has been found to be overly complex and there is a lack of clarity on its return on investment – the outcome of the review is expected in early 2019.

 A few thoughts

ICSs promise a more joined-up approach to health care but issues around governance and accountability for NHS organisations and local authorities still risk stymieing efforts to work more collaboratively. As part of the LTP’s new way of working, many initiatives will require cross organisational actions with trusts and commissioners working collaboratively to agree the services that each organisation will provide and the cost of those services, ensuring these are affordable and within the ICS’s collective financial budgets.

The LTP lists a number potential legislative changes that would support the ICS agenda:

• Let trusts and CCGs exercise functions, and make decisions, jointly in order to support the more effective running of ICSs .
• Give CCGs and NHS providers shared new statutory duties to promote the ‘triple aim’ of better health for everyone.
• Remove specific impediments to ‘place-based’ NHS commissioning.
• Support the creation of NHS integrated care trusts under a single, streamlined ICP contract.  

Supporting the case for change and a system more flexible

Dudley CCG has led work on developing a new model for integrated primary, community and mental health services, with the Dudley MCP looking to go live on 1 April 2020.

We are running a series of free seminars on the LTP and what it means for the health and care sector this spring. If you would like to receive an invitation or register your interest, please email [email protected].

Do get in touch with Rhian Vandrill or Charlotte Lewis if you’d like to know more about Dudley CCG’s MCP project or to discuss ICSs further.