Integrated Care Systems, Integrated Care Boards and Integrated Care Partnerships; A brief explainer
Integrated Care Systems (ICSs) are local partnerships made up of NHS organisations, local authorities (Councils), VCSEs (voluntary, community and social enterprises) and other stakeholders who support the local population’s health and wellbeing.
ICSs were created by statute in 2022 to support delivery of integrated care, tailore
d to the needs of local communities across England. There are 42 ICSs across the country, each of which serves a population of between 0.5 million and 3.5 million people. A map showing the geographical footprint of each ICS is available on the NHS England website.
NHS ICSs have four key aims :
- To improve outcomes in population health and care
- To reduce inequalities in outcomes, patient experience and service access
- To enhance productivity and value for money
- To help the NHS support broader social and economic development
To deliver against these aims, each ICS has two local statutory bodies which support the planning and delivery of health and care services; an Integrated Care Partnership and an Integrated Care Board.
Integrated Care Partnerships (ICPs)
Are committees responsible for developing an integrated care strategy for their ICS area, building on local joint strategic needs assessments and engaging with local communities. Each ICP is jointly run by NHS organisations and local authorities. Other stakeholders may also be invited to be members of, or to partner, with an ICP. Broader stakeholders may include social care providers, VCSEs and organisations not traditionally associated with care giving, but which support local people’s wider health and wellbeing needs e.g. housing and education providers and employer representatives.
Integrated Care Boards (ICBs)
Are NHS organisations which plan health services and manage the NHS budget for the population within their ICS. Prior to the introduction of ICBs, responsibility for commissioning health services was held by local Clinical Commissioning Groups (CCGs). Each ICB works with local NHS providers within the ICS including primary and secondary care, to develop and maintain a 5-year plan detailing how the local NHS bodies will support the integrated care strategy produced by the ICP. The ICB plan must also align with the health and wellbeing strategies developed by Local Authority ‘Health and Wellbeing Boards’ within the ICS footprint.
The need for Integrated Care Systems
The awarding of statutory powers to ICSs, ICBs and ICPs through the 2022 Health and Care Act recognised the broader determinants of individuals’ health and wellbeing e.g. housing and employment and the widespread inequalities in health. It also recognised the need for the care received by individuals to be co-ordinated locally by different providers including the NHS, social care, VCSEs and other providers. Through collaborative planning, resourcing and delivery, ICSs seek to meet these challenges to improve patient care and organisational efficiency and effectiveness.
A simple example might be the co-ordination of care around an elderly patient on discharge from hospital. Delays in finding suitable support within the community for such patients can lead to unnecessarily long stays in hospital, which in itself impacts patient experience, but which can also lengthen the time for recovery once a patient returns home and impact longer term patient outcomes. Clearly, an unnecessarily long stay in hospital also ties-up secondary care resources and means one less bed available for other patients.
To prevent this type of scenario, partners within an ICS can collaborate to co-ordinate care. One such successful initiative is the Sefton CVS Hospital Discharge Service described in this NHS England case study. The Discharge Service ensures wrap-around care for patients leaving hospital and for their carers.
To address the same issue, one of our Community Trust clients works closely with secondary care providers to streamline hospital stays for patients. For example, community nurses visit local hospital wards daily and work with secondary care colleagues to plan for an elderly patient’s discharge from the day the patient arrives in the ward.
Patients are encouraged to maintain independence as much as possible during their stay e.g. getting dressed first thing every day rather than remaining in night clothes, moving around where possible and sitting in a chair rather than lying in bed. Community staff have detailed knowledge of support available within the community and can advise on community and voluntary sector services which can support even the frail elderly to leave hospital in a timely fashion.
With the population living longer and an increasing number of patients with multiple long-term conditions these types of initiatives are vital for both patient welfare and the sustainability of the system.