The future of integrated care in England

How we got here? 

The introduction of new Integrated Care Systems across NHS England is the biggest legislative overhaul of the NHS in a decade, yet, integrated care is not a new issue. Access to joined-up care and support is a challenge we have faced as a nation for many years.¹ Prior to the Health and Care Act 2022, the NHS was made up of 106 clinical commissioning groups (CCGs) across England.² Clinical commissioning groups (CCGs) were clinically-led statutory NHS bodies responsible for the planning and commissioning of healthcare services for their local area.    

In 2014, the NHS set out to develop more joined-up health and care, describing the need for “triple integration” between hospitals and GPs, the NHS and social care, and physical and mental health.³ Since this time, there have been a number of stepwise approaches to get to where we are today, further accelerated by the COVID-19 pandemic.³ 

Integrated care systems have existed informally since 2016.⁴ The NHS Long-Term Plan set a goal that by April 2021, all of England would be comprised of 42 Integrated Care Systems.⁵ Going one step further, as of July 2022, statutory Integrated Care Systems were established as part of the Health and Care Act 2022. ⁶ These are healthcare partnerships that bring together the health and care organisations’ in local areas.  

Integrated care systems provide a major structural change for the NHS in England that will have important implications for the future of service delivery.  

What do the changes mean? 

The 42 integrated care systems across the country will bring together professionals from local councils and the NHS, as well as voluntary and community organisations, to pool resources and find the best ways to support local people.¹   

Integrated care systems are made up of two constituent parts 1) an integrated care board and 2) an integrated care partnership. Integrated care boards decide how the NHS budget for their area is spent and are responsible for workforce planning. Integrated care partnerships bring the NHS together with other key partners to develop strategies for improving health and well-being in a specific geographical area.⁷ 

Integrated care systems aim to tackle the root causes of ill-health, such as poor housing or unemployment by working in partnership with the health and care organisations, as well as other sectors.¹ By acting sooner, integrated care systems intend to support those with preventable conditions.⁸  

The change will also mean the amalgamation of different organisations’ budgets, with the purpose of investing in services to meet the specific needs of the areas they serve.¹ 

Previously, the NHS has focussed on treating single conditions individually, but as our population ages, integrated care systems will help to provide regular, ongoing care for those with multiple conditions and needs. Integrated care systems will avoid the patchwork of organisations working independently from one another, which has been a difficult system to navigate for patients with multiple conditions.⁷ However, we must remember that these new NHS structures are not homogenous and vary markedly based on their locality, resource capacity and socio-economic demographic.   

One size does not fit all 

The challenges facing each of the new integrated care systems are not the same, as pressures and resources vary widely between areas.⁴  

The range of people each integrated care system covers is large. The smallest covers a population of just over 500,000 (Shropshire, Telford and Wrekin), while the largest covers more than 3 million people (North East and North Cumbria).⁴ Similarly, workforce capacity varies greatly, with 47 GPs per 100,000 population in Kent and Medway, but nearly 69 per 100,000 population in Herefordshire and Worcestershire.⁴ 

Differences will be observed in how well local areas have worked together historically. The existing relationships between hospitals, GPs, and other agencies will shape how integrated care systems develop. The areas that have been pioneers in integrated care will predictably have a head start, compared to areas that were not previously working in alliance.⁴

Differing levels of health inequality also exist between areas, something that aims to be diminished with the introduction of statutory integrated care systems. For example, the Core20PLUS5 approach focuses on reducing inequalities by targeting efforts at people living in the 20% most deprived areas.⁴

National policy will need to acknowledge this variation and be realistic about what different areas can achieve. For example, some areas will need to be provided with additional resources to help deliver national policy objectives.⁴ The new changes have sparked criticism and controversy from a number of quarters.

Criticism and concerns

Not everyone is 100% happy with the move to integrated care systems. Concerns have been raised in relation to their accountability and transparency, as they were previously non-statutory. Now that integrated care systems have been placed on a statutory footing, this will require more robust governance structures to ensure an effective transition.⁹  

Other critics believe that integrated care systems could be the start of a back-door privatisation of the NHS. However, partnerships with the public sector are unlikely to lead to a larger role for private companies in delivering NHS services.⁹ 

Concerns have also been raised regarding the evidence base for the efficacy of integrated care systems. An analysis of 13 pilot integration areas in 2021 found that delayed transfers of care increased by an average of 24% between 2016 and 2020, compared to 9% for the rest of England in the same period.¹⁰ Despite these findings, putting integrated care systems on a statutory footing still went ahead. It remains to be seen whether these doubts will be proven right following the introduction of the new system. What is clear, is that organisations wishing to engage with the health service will have to navigate a significantly different healthcare landscape following these changes. 

Onyx Health are here to help

Commenting on the recent change to NHS England, Onyx Health’s Executive Director Director Trevor Pill said “The new integrated care systems represent a major structural and organisational change for NHS England. Change like this is never easy, especially for an organisation as large and complex as the NHS, and there are likely to be teething problems during the transition. We all know that navigating the complexity of NHS structures can be a logistical challenge for businesses in the pharmaceutical and life sciences industry wishing to engage with the health service. At Onyx Health, we are healthcare marketing communication experts with over 30 years of experience in the sector. Having the right communication strategy in place that includes knowing who your customers are and how to target them will be essential to help businesses adapt to this new commercial environment and rise to the challenge.

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