MPs call for “urgent action” to ensure opportunities of Integrated Care Systems are realised

An inquiry by the Health and Social Care Committee has found “genuine enthusiasm” for the potential of Integrated Care Systems (ICSs) to deliver on challenges facing the health and care sectors, but warns of a “serious lack of clarity” in some areas.

The MPs on the committee have called on the Government and NHS England to address key concerns if an “opportunity to deliver real change is to be realised”, highlighting the risk that acute short-term pressures could be given priority over longer term ambitions such as preventing ill-health.

The restructuring programme established 42 Integrated Care Systems (ICSs) in England that came into force in July 2022.  

The committee also expressed concern that the success of the restructuring programme could be jeopardised if NHS England continue to take a “command and control” approach.

The report says it is “vital that the Government and NHS England should not dictate how ICSs deliver local outcomes”.  

The committee note that improved outcomes in population health and healthcare are a “core purpose” of ICSs, however, public health professionals are “not mandated to sit on Integrated Care Boards”.

The MPs voice concern that without this expertise, “longer-term priorities will not be addressed”, and the changes instead will continue “a sickness service” rather than produce a health service fit for the future. 

The report outlines some key recommendations to Government/NHS England: 

• Targets for ICSs set by DHSC and NHS England should be based on outcomes, greater prescription around how targets are achieved should be done sparingly.
• Any update to NHS England's Long-Term Plan must put prevention and long-term transformation at its heart.
• Integrated Care Boards should ensure they include a public health representative, such as a public health director or public health lead.
• DHSC should gather information relating to the membership of ICBs and then review to understand whether further mandating is required.
• DHSC, working with ICSs, should set out action that could be taken to resolve issues of poor partnership working, especially with social care.
• DHSC should urgently provide the CQC with its decision on ratings and any priorities it would like the CQC to focus on.

Chair of the Health and Social Care Committee Steve Brine MP said: “This is a key moment for ministers and for NHS England. We have found genuine enthusiasm for the potential of Integrated Care Systems to make a real change, not only in how health and social care is delivered but in prioritising the needs of local populations and preventing ill-health.  

“It would be an opportunity lost if that success was undermined by the need to prioritise central government targets or a focus on meeting short-term demands. We urge ministers not to lose sight of the crucially important prevention agenda and we call for them to adopt a light-touch outcome driven approach to this new way of working.   

“We were pleased that the Government commissioned the Hewitt Review, considering similar themes to our own inquiry, and welcome the spotlight that is being shone on ICSs at this early stage in their development. We hope to see this focus maintained and look forward to considering the Review’s findings.” 

In response to the report, Sarah McClinton, President of the Association of Directors of Adult Social Services said: “The committee’s report hits the nail on the head. Integrated Care Systems have the potential to create the sort of health and care system we need, where we prevent ill health by providing high quality, timely care and support when people need it in their homes and their community. And where decisions about care are made by the people accessing it and the frontline staff supporting them as much as possible.

“But these reforms could easily be derailed. MPs are right to challenge the NHS and the Government to focus targets on outcomes and not try to dictate from the top-down what activities should be prioritised. Integrated Care Systems should be about genuinely sharing power, shifting decision making closer to people and ensuring they are not just about NHS services, but have social care, public health services and the voluntary sector at the heart of decision-making and delivery."

McClinton added: “Critically, the Government needs to ensure that Integrated Care Systems are not just left to deal with the immediate crisis in health and social care. If they are genuinely going to build a health system that acts for the long-term, investing in way to prevent ill-health and improve well-being in their communities, they will need the resources to do that. And they will need the Government to intervene to solve the current crisis. That includes a long-term, fully funded plan to reform adult social care, so we can address the staffing crisis and have sustainable funding that will meet the needs of all older and disabled people and their carers in future.

“We look forward to the publication of the forthcoming Hewitt Review the Government has commissioned on making Integrated Care Systems achieve their potential. We hope it contains a similarly robust set of actions to ensure that Integrated Care Systems help build the health and care system we all need.”

Lottie Winson