What are Integrated Care Systems (ICS)?

The Health and Care Act was passed in April 2022, putting Integrated Care Systems (ICS) – which have existed in shadow form for several years – on a statutory footing from 1st July 2022. This means they are now responsible for planning and funding health and care services in the area they cover.

The establishment of Integrated Care Systems (ICS) is the first large-scale structural change to the NHS since 2012. These new bodies are a core part of the NHS Long Term Plan from 2019 and build on how services have already been working together at local levels in a variety of ways to orientate health and care much more around the people they serve rather than their organisational boundaries.

What are Integrated Care Systems?

Integrated care systems (ICSs) are partnerships of organisations (providers, commissioners, and local authorities & partners) across a geographical area to collectively plan and deliver joined-up health and care services and to improve the lives of people who live and work in their area.

The 42 integrated care systems take over from the now-dissolved 106 NHS Clinical Commissioning Groups (CCGs) and will be responsible for planning healthcare services to populations in their local areas.

Each ICS is made up of:

Integrated care board (ICB)

A statutory NHS organisation responsible for developing a plan for meeting the health needs of the population, managing the NHS budget and arranging for the provision of health services in the ICS area. The establishment of ICBs resulted in clinical commissioning groups (CCGs) being closed down. They have both a chief executive and chair, and they are accountable to NHS England for NHS spending and performance within their boundaries.

Integrated care partnership (ICP)

The ICP is a statutory joint committee formed by the NHS integrated care board and all upper-tier local authorities that fall within the ICS area. It brings together a broad alliance of partners concerned with improving the health and wellbeing of the population, with membership determined locally. The ICP is responsible for producing an integrated care strategy on how to meet the health and wellbeing needs of the population in the ICS area.

Local authorities

Local authorities in the ICS area, which are responsible for social care and public health functions as well as other vital services for local people and businesses.

Place-based partnerships

Within each ICS, place-based partnerships will lead the detailed design and delivery of integrated services across their localities and neighbourhoods. The partnerships will involve the NHS, local councils, community and voluntary organisations, local residents, people who use services, their carers and representatives and other community partners with a role in supporting the health and wellbeing of the population.

Provider collaboratives

Provider collaboratives will bring providers together to achieve the benefits of working at scale across multiple places and one or more ICSs, to improve quality, efficiency and outcomes and address unwarranted variation and inequalities in access and experience across different providers.

What is the purpose of integrated care systems (ICSs)?

The purpose of ICSs is to bring partner organisations together to:

• improve outcomes in population health and healthcare
• tackle inequalities in outcomes, experience and access
• enhance productivity and value for money
• help the NHS support broader social and economic development.

Collaborating as ICSs will help health and care organisations tackle complex challenges, including:

• improving the health of children and young people
• supporting people to stay well and independent
• acting sooner to help those with preventable conditions
• supporting those with long-term conditions or mental health issues
• caring for those with multiple needs as populations age
• getting the best from collective resources so people get care as quickly as possible.

The journey to integrated care systems in every area

Developing more joined-up health and care has been a bottom-up, step-by-step journey for the NHS and its partners, building on the expertise of frontline staff and learning from what works well in different areas.

In 2014, the NHS set out a widely supported vision for the future, describing the need for “triple integration” between hospitals and GPs, the NHS and social care, physical and mental health, and kicked off vanguard projects around the country.

In 2016, NHS England asked all parts of England to begin planning together in new partnership formed of all NHS organisations, local government and others, setting out their early thinking and working with partners to develop them.

In 2018, it named the most advanced parts of the country as the first integrated care systems, with NHS England working closely with them to pioneer best practice.

In 2019, the NHS Long-Term Plan set the ambition for all parts of the country to become integrated care systems by April 2021 – “the biggest national move to integrated care of any major western country.”

In 2019, NHS England recommended that government unblock legislative barriers to integrated care following a major engagement exercise to identify consensus across the health and care system.

In 2020, the COVID-19 pandemic accelerated integrated working as health and care leaders joined forces to support people at risk, offer each other mutual aid, and deliver the vaccine programme.

In November 2020, the NHS set out next steps for creating strong integrated care systems in every part of the country and launched an engagement exercise on enhanced proposals for creating statutory ICSs.

In January 2021, the NHS confirmed its legislative recommendation to government – making important adjustments to reflect feedback from local government in particular – and the government took this forward in its White Paper in February.

In April 2021, Sir Simon Stevens announced that all 42 parts of England had been declared integrated care systems.

In July 2021, the government published draft legislation proposing the creation of statutory ICSs.

In April 2022, the government passed the Health and Care Act 2022, confirming the creation of statutory ICSs.

1st July 2022, statutory ICSs arrangements are established.

Integrated care system leadership

ICB chairs and designate ICB chief executive officers (CEOs) have been appointed in most integrated care systems, as set out here – https://www.england.nhs.uk/integratedcare/ics-leadership/