Integrated Care Systems are “a missed opportunity” say Public Accounts Committee

Integrated Care Systems (ICS) are likely to struggle to make progress on local or longer-term priorities such as increasing healthy life expectancy and reducing avoidable ill-health, according to a new report by the Public Accounts Committee.

This is because the government is too focused on shorter-term challenges such as the elective care backlogs and A&E waiting times. There is also “Paralysis by analysis” as crucial projects are repeatedly delayed.

In July last year 42 ICSs were established across England as part of the new Health and Care Act. The aim was to bring commissioners and service providers of health services together with local authorities and partners to plan and deliver integrated services to improve the health of the local population.

However, the Public Accounts Committee which examines the value for money of government projects, said that the major new reform will not work until government addresses multiple chronic issues in the service such as decrepit NHS estate, record treatment backlogs, in addition to workforce and financial issues.

The four core purposes of ICSs are to: improve outcomes in population health and healthcare; tackle inequalities in outcomes, experience and access; enhance productivity and value for money; and help the NHS support broader social and economic development.

Jury is still out on benefit of ICSs

The report said that at a national level, not enough is being done to focus on preventing ill-health nor is there any effective arrangements for joint working between government departments to tackle the causes of ill-health.

It concluded: The ‘Integrated’ element of ICSs as well as their accountability arrangements appear under-developed: there is a concerning lack of oversight for ICSs. NHS England’s core responsibilities for overseeing the delivery of healthcare in the NHS absorbs most of its focus.

“The lack of leadership from the Department on the relationship between health and social care is worrying and could mean ICSs become a missed opportunity to make meaningful progress on how the NHS and local government work together. It is not clear who will intervene if joint working between the NHS, local government and other partners breaks down, and local health bodies’ responses to concerns raised by MPs on behalf of their constituents have been very patchy. In short, on ICSs, the jury is clearly still out.”

Lead Public Accounts Committee member Anne Marie Morris MP said that while the ambition is right, the tool kit simply isn’t there to deliver on it.

She added: “Everything changes yet nothing changes. ICSs are the latest iteration of a plan to organise the NHS and integrate health and social care. As one of the biggest spending departments funded by taxpayers, more transparency is needed to show what, how and by when the taxpayer will see not just an improvement but a health and care system that works and is truly there when it’s needed.”

What does this mean for the future?

The King’s Fund warned at the start of the year that deep performance challenges in the health and care system may draw ICSs into being simply another layer of performance management. With so many visible challenges in the acute sector they may also end up side-lined as the day-to-day business goes on between the centre and trusts.

Public Accounts Committee chair, Dame Meg Hillier MP, agreed with this and said that the ICS reforms have potential but there is no clear responsibility for ensuring that social care is properly integrated with healthcare or that patients will see the difference on the ground.

She added: “Far from improving the health of the nation, staff shortages and the dire condition of the NHS estate pose a constant risk to patient safety. But government seems paralysed, repeatedly rethinking and delaying crucial interventions and instead coming up with plans that do nothing to address the fundamental problems of funding and accountability.

“Changes will not succeed if they are imposed on the NHS in its current state. Government needs to get a grip on the wider, full-blown health and social care crisis it allowed to develop from long before the pandemic.”

Need to move NHS and social care away from a constant state of emergency

The NHS Confederation was more cautiously optimistic. It said that the introduction of ICSs was overwhelmingly supported by the sector, but they were never intended as a silver bullet that will solve all the entrenched challenges facing the NHS and social care.

Judging their success on this, and after only seven months since entering the statute books, would be unfair as we know these macro issues require additional investment and support at a national level.

Sarah Walter, director of the ICS Network at the NHS Confederation, added: “The committee is right to note that in order to allow these new bodies to thrive, more needs to be done to move NHS and social care away from a constant state of emergency. This means allocating appropriate levels of sustained capital investment, delivering on the workforce strategy, moving away from overly bureaucratic and prescriptive national targets, and bringing an end to the intensifying waves of industrial action where huge amounts of time and resource are having to be set aside to fire-fight.

“Once these issues are resolved we will begin to see more tangible progress on improvements to population health outcomes in the years ahead.”