A year of integrated care systems
Reviewing the journey so far
Authors: Anna Charles, Lillie Wenzel, Matthew Kershaw, Chris Ham and Nicola Walsh
Where once the primary purpose of the health and care system was to provide episodic treatment for acute illness, it now needs to deliver joined-up and proactive support for growing numbers of older people and people living with long-term conditions and complex needs. Severe constraints on NHS and social care funding since 2010 have put the system under enormous strain, and it is clear that simply working current models of care harder is not the answer. Instead, the NHS and its partners need to work differently, breaking down barriers between services and giving greater priority to promoting population health and wellbeing.
In March 2017, NHS England set out an ambition to ‘use the next several years to make the biggest national move to integrated care of any major western country’ (NHS England 2017, p 31). This aim is now being pursued through the development of sustainability and transformation partnerships (STPs) – local ‘place‑based’ partnerships of NHS and local authority organisations. The most advanced local partnerships have been asked to develop ‘integrated care systems’ (ICSs). These systems will take more control of funding and services across local areas. It is hoped that by collaborating across organisational boundaries, they will make better use of the resources available to them and improve the health and wellbeing of their populations.
Ten areas of England were selected to develop the first ICSs. Many if not all of these systems have been building partnerships to join up local services for several years, and their journeys as integrated systems can often be traced back to well before the latest national initiatives. As they work to embed and formalise these arrangements, the systems are seeking to create a different way of working in the NHS, moving away from siloed working and competition between providers, towards collaboration and a focus on places, populations and partnerships. International examples where progress has been made in creating joined-up, place‑based systems of care – for example, the Canterbury system in New Zealand and the Nuka system in Alaska – highlight the improvements that can be achieved by working in this way (Charles 2017; Collins 2015; Timmins and Ham 2013).
Work to support integrated care and improve population health needs to happen at a number of different levels. Some of this work is taking place across systems of care, however, much of the focus is on smaller, identifiable geographies such as local towns and neighbourhoods (Ham 2018b). It will be important to establish what the role should be for these larger systems – which often have several distinct places within them – and what contribution they can make to the pursuit of integrated care.
The King’s Fund strongly supports the development of ICSs. They embody the arguments we have put forward on place-based systems of care and population health and offer the best hope for the NHS and its partners to bring about improvements in health and care for their populations (Alderwick et al 2015; Ham and Alderwick 2015). It is early days in their development; the first systems have only been in existence for a little over a year and they have been described as ‘nascent and fragile’ (Ham 2018a). The challenge facing national bodies and ICS leaders is to allow time and provide support to ICSs to build on the foundations that have been laid and to remove barriers to progress.