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Integrated care systems held back by ‘conflicting messages’ from national bodies

While there have been encouraging signs of progress, integrated care systems (ICSs) are nevertheless being held back by their regulatory relationship with NHS England and NHS Improvement (NHSI), as well as by sluggish regional teams who have been too slow in aligning their approach.

In its comprehensive review of eight first-wave ICSs, The King’s Fund concluded that the integration model has “real potential to bring about improvements,” despite the fact that there is limited evidence of tangible reform to date due to their short existence.

But certain “significant barriers” to progress still exist and need to be addressed urgently.

For example, despite promises that the enviable ICS status would mean an improved ‘one-stop shop’ regulatory relationship with , their experience in practice “remains largely unchanged.” There is still intense focus on organisational performance and accountabilities, as well as conflicting messages from the two national bodies.

Regional teams have also been “slow to align their approach with local systems,” in stark contrast to the national ICS programme – which has “taken a permissive and supportive approach” and is generally viewed positively by local teams.

According to the influential think tank, the challenge that exists now is to build on the foundations that have been laid so far by removing persistent barriers and providing enough time and support to ICS leaders so that they can take their work to the next level.

“As this happens, the understandable desire to see change happen quickly needs to be married with realism about the scale and complexity of what is being attempted,” the King’s Fund warned.

Despite this cautionary statement, its comprehensive analysis of the first ICS bodies showed some reassuring signs of early success. Individual bosses are now spending more time looking outside of their own organisations to lead across systems, which has resulted in a shift in perspective; and there has been a keen focus on establishing the right governance needed to work as systems.

In fact, the most advanced ICSs are those that are fully working as systems and have given due priority to strengthening collaborative relationships and trust between each partner organisation.

“This has often been achieved by establishing common cause, spending time together, and undertaking focused development work with their leadership groups,” the report said. “Some ICSs have found it more difficult than others to establish common cause among partner organisations.”

As well as a need to invest in collaborative relationships and promote system leadership, amongst the King’s Fund’s nine recommendations for local systems was a need to build up from places and neighbourhoods; draw on the skills of frontline staff; develop active strategies to facilitate wider adoption of new care models; and look beyond the health and care system to improve population health.

NHE is attending The King’s Fund’s official report launch today at its integrated health and care summit. Follow our Twitter to keep up to date with developments.



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