Integrated care systems (ICSs) are being held back by underinvestment in workforce and capital alongside a lack of a clear plan for social care, a new report from the NHS Confederation has found.
For the project, the NHS Confederation polled health service chiefs and chairs to understand the current state of ICSs and how best to chart a path for the future.
The survey revealed that ICS leaders believe staff pressures, financial constraints, issues in the social care sector – alongside the continued disruption from industrial action – is making both short and long-term targets difficult to achieve.
The report also found that leaders are supportive of ICSs and have made good initial progress in their first year, but more needs to be done to optimise output, including:
- The publication of a social care workforce plan
- A breakdown of capital funding and the complex allocation process in the spending review
- NHS England working with integrated care boards (ICBs) to facilitate access to the requisite data and capacity to effectively discharge their new commissioning functions
- Giving ICSs more autonomy in how they choose to meet various targets, as well as a smaller number of said targets
- Normalising the co-production of guidance and policy that affects ICSs – in particular, system accountability arrangements
Despite the need for improvement, health leaders were positive about ongoing partnerships with nine in 10 respondents indicating that targets are being established and delivered in a collaborative manner. This was the same for those who thought ICBs and integrated care partnerships were working well together.
Most leaders also reported positively about the new responsibilities ICBs have recently taken on, including the commissioning of community pharmacy, optometry and dentistry services.
Nine out of 10 ICB leaders felt prepared for pharmacy and optometry services, while seven in 10 felt prepared for dentistry. This was in conjunction, however, with concerns around the dearth of relevant and high-quality data for these services alongside significant challenges in relation to the national dental contract.
Respondents also highlighted complete devolution as a key area of opportunity, although only 45% believed that ICSs currently devolve decisions to their most local level.
Director of the NHS Confederation’s ICS network, Sarah Walter, said: “ICS leaders are proud of the progress they’ve made in really tough conditions but they are deeply frustrated by some of the potentially soluble barriers that are hindering the extent to which they can get on with transforming services for their local communities.”
“They want to see these tackled urgently if ICSs are to fulfil their full potential,” she added.
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