Shifting care into the community: Using Ostrom to explore collaborative care delivery with shared resources in English NHS Integrated Care Systems

Enabling the delivery of efficient and effective healthcare services within a constrained financial environment is an enduring challenge. Shifting care from hospital to community settings is therefore a priority in many countries where it is hoped that they will reduce demand on hospital services and overall health system costs. In English Integrated Care Systems (ICSs) this is being done through new collaborative care processes involving community health services such as virtual wards. However, despite their critical role in integrated care, community health services have been relatively under-researched. Using Ostrom’s theories of common pool resources, including principles for the use of finite resources for shared action, we examine whether ICSs in England can self-govern shared resources for collaborative services delivery. Drawing on the perspectives of community health services providers and ICS stakeholders who commission and manage them, we find a lack of proportional equivalence between costs and benefits for community health services providers. An enduring lack of visibility of community health services within the system suggest that the conditions for sustained collaboration between providers are not being met. This means that the policy intent for ICSs to facilitate more collaborative care and shift care from hospital to the community may not be realised.