The development of Integrated Care Systems in the English NHS: progress so far and the challenges ahead

Integrated care systems are partnerships bringing together NHS organisations, local government and others to take collective responsibility for planning services, improving health and reducing inequalities. They have existed since 2016 as informal partnerships and in 2022 became formalised as legal entities with statutory powers and responsibilities, including responsibility for around 70% of the NHS budget in England. There are now 42 ICSs across the country, each covering populations of between 500,000 and 3 million people. The King’s Fund has been tracking the development of ICSs since 2016 through a series of research studies. We currently have three studies underway to understand how ICSs are functioning since becoming statutory organisations in 2022, and the extent to which they are achieving the original policy objectives. Each of these studies is taking a distinctive lens through which to examine the development of ICSs: 1.The role of ICSs in addressing workforce challenges in health and social care. In this study, we are examining the extent to which ICSs are creating a platform to develop collaborative, whole-system solutions to one of the most significant challenges facing the health and care system in England and internationally: the recruitment, development and retention of a workforce capable of meeting population needs now and in the future. The research involved 30 in-depth qualitative interviews with local leaders in 4 case study ICSs. We also held a series of workshops to engage with a broader set of ICS leaders for the purpose of challenging and testing our emerging findings. 2.The role of ICSs in improving dementia diagnosis. In this study, we are focusing on a specific care pathway – dementia diagnosis – with the objective of understanding the role that partnership working in ICSs is playing (or could play in future) in driving improvement. We are focusing on dementia care as an example of a care pathway that requires an integrated approach across multiple partner organisations. The research is based on a case study design, with approximately 20 qualitative interviews with a range of stakeholders (including people living with dementia) in 3 case study ICSs. We are also conducting a roundtable to explore the implications of our findings for national policy on ICSs. 3.Place-based working within ICSs. An important part of the policy vision for ICSs is that much of the practical work of delivering integrated care needs to happen locally. To enable this, more local ‘place-based partnerships’ have been created in most ICSs, each covering a smaller geography within the ICS. This study aims to understand how these place-based partnerships are functioning, what roles they are performing and the extent to which they are taking on delegated budgets and responsibilities from ICSs. To do this we are conducting a national survey of ICS place leaders as well as qualitative fieldwork. This presentation will bring together the findings of these three studies to provide an authoritative and up-to-date picture of the implementation of ICSs in England and the learning for other countries.