In England, an integrated care system (ICS) is a statutory partnership of organisations who plan, buy, and provide health and care services in their geographical area. The organisations involved include the NHS, local authorities, voluntary and charity groups, and independent care providers. The NHS Long Term Plan of January 2019 called for the whole of England to be covered by ICSs by April 2021. On 1 July 2022, ICSs replaced clinical commissioning groups in England.
Statutory bodies
The Health and Care Act 2022 put these systems on a statutory basis, each with an approved constitution. On 1 July 2022, a total of 42 ICSs became statutory. There are more than 70 performance metrics by which they are judged, grouped into six "oversight themes": quality, access and outcomes, preventing ill health and reducing inequalities, leadership, people, and finances. The poorest performers will be put in a "recovery support programme", which will replace the label of special measures. Each system is to set their own constitution, determine staff pay and can raise "additional income" but the chair must be approved by the Secretary of State for Health and Social Care.
The areas covered by each ICS vary considerably by population and demographics. Population size ranges from 500,000 to more than 3 million people. Some have more than 10 upper-tier local authorities and some only one. Nearly 50% of the neighbourhoods in Birmingham and Solihull are in the most deprived fifth of the neighbourhoods nationally, compared to 1% in Surrey Heartlands.
Governance
NHS England produced a model constitution in July 2021, which systems are expected to use when developing their own arrangements. Each ICS must have an integrated care board with at least five executive directors and three non-executives.
Integrated care partnership
The boards must work with local authorities to create an integrated care partnership (ICP) committee for each system, to include local organisations such as the voluntary sector and social enterprises. The ICP works on prevention, wider social and economic factors affecting health, and reducing health inequalities.
Pharmacy
Each ICS is to have a community pharmacy clinical lead, funded by the Pharmacy Integration Programme for the first two years.
History
The first accountable care systems (2017) Eight sustainability and transformation plan areas in England were named in June 2017 by Simon Stevens, chief executive of NHS England, as a first wave in the development of what were then called accountable care systems. He said they "will bring together providers and commissioners to help break down barriers between primary, secondary and social care". They would be given up to £450 million between them in transformation funding over the next 4 years. The eight were:
Frimley Health and Care System – a consortium of 30 public and private care providers with five clinical commissioning groups, five GP federations, 10 local, district and county authorities, two ambulance trusts and five mental health and community providers including Virgin Care; South Yorkshire and Bassetlaw – seven NHS hospital trusts covering 15 hospital sites, which employ 45,000 staff and service 2.3 million residents; Nottinghamshire – with an initial focus on Greater Nottingham and the southern part of the sustainability and transformation partnership; includes seven public bodies and Circle Health; Blackpool and Fylde Coast, with the potential to spread to other parts of the Lancashire and South Cumbria STP at a later stage; Dorset; Luton, with Milton Keynes and Bedfordshire; West Berkshire; Buckinghamshire.
Greater Manchester was not included because it already had more advanced arrangements under its 2015 "devolution" deal. Surrey Heartlands began a similar arrangement in 2018.
In each area a provider or, more usually, an alliance of providers will collaborate to meet the needs of a defined population with a budget determined by capitation. There will be a contract that specifies the outcomes and other objectives they are required to achieve within the given budget over a period of time. This may extend well beyond health and social care services to encompass public health and other services. In Manchester, the objectives are specified over ten years. Keeping people out of hospital by moving services into the community is a common feature. NHS trusts, Clinical Commissioning Groups and local authorities in the new ACSs will "take on clear collective responsibility for resources and population health".
