The state of Integrated Care Systems: key insights from the regions

Integrated Care Systems are beginning to embed as formal partnerships since their formal establishment in July 2022. The Hewitt review acknowledged that they had been born in “difficult times” but that they were “already making a difference”.

Progress to date looks different across different systems, places and neighbourhoods depending on the local factors such as geographies, levels of maturity and the specific needs of local populations.

Public Policy Projects’ latest reports following the ICS Delivery Forums in the West Midlands, Manchester, and Leeds provide key insights into the success and challenges of ICSs one year on. Panel discussions have featured stakeholders from different parts of local systems, experts and relevant private sector organisations.

Our commercial health lawyers, Rhian Vandrill and Charlotte Lewis have been part of these discussions sharing insights on overcoming barriers to developing partnerships from provider collaboratives to place based partnerships.

We share a few insights from the regions:

West Midlands

On overcoming data-sharing barriers, Rhian Vandrill commented:

“Data sharing and governance is particularly an issue for provider collaboratives…what we have been able to do is facilitate the exchange of data that’s needed for the success of the collaboration through the creation of additional arrangements, but also to enable the information barriers to exist, to preserve certain patient data flows.”


On governance, Charlotte Lewis suggested:

“…that despite the statutory duty to collaborate being enshrined in legislation, issues around governance, competitive cultures and finance are still proving challenging…the best examples of successful collaborations could be found where ICSs as a whole have looked at their collaborative makeup and thought about how to break down the silos so that these collaboratives can actually work together.”


On collaboration in the North East and relinquishing control, Charlotte described Mills & Reeve’s work with provider collaboratives, much of which focuses on risk, governance and funding arrangements.

Charlotte explained:

“…while workforce and resource constraints are common barriers to effective collaboration, these can be overcome by governance arrangements that see each constituent part sharing resources, risk and administrative functions..We’re definitely seeing a shift in terms of clients looking at delegated decision making, delegated budgets and delegated functions”.

One such example is the South Yorkshire ICS, which “has created a hub that pools functions like commissioning, administrative functions, and is looking at financing. The hub also has an oversight role and also helps with information and data sharing where there are barriers that are legally required.”


It is apparent from the Delivery Forums that NHS providers, independent organisations and the VCSE sector are growing accustomed to the new collaborative environment that ICSs have been established to create. Despite this, collaborating with one another, rather than competing, is still new territory for many organisations, and clearer guidance and support from the government may be necessary to enable effective governance and risk-sharing to take place.

Future Delivery Forums

It will be interesting to hear the outputs of today’s Bristol Delivery Forum and the London Forum on 1 November – the event is free for the public sector and third sector organisations. If you’re planning to attend do come and say hello to Rhian and Charlotte.

You can read PPP's insight reports here.

Our content explained

Every piece of content we create is correct on the date it’s published but please don’t rely on it as legal advice. If you’d like to speak to us about your own legal requirements, please contact one of our expert lawyers.

Posted by


Mills & Reeve Sites navigation
A tabbed collection of Mills & Reeve sites.
My Mills & Reeve navigation
Subscribe to, or manage your My Mills & Reeve account.
My M&R


Register for My M&R to stay up-to-date with legal news and events, create brochures and bookmark pages.

Existing clients

Log in to your client extranet for free matter information, know-how and documents.


Mills & Reeve system for employees.