The march of the integrated care system

Organisations which deliver integrated care have been quietly developing over the last several years. Many have evolved from vanguards, which became sustainability and transformation partnerships (STPs) and have now morphed into Integrated Care Systems. Their brief and ambition was to work together to deliver care differently – who with, and how, they worked together was down to the partners to determine and there were many different models which emerged.

NHS England states that integrated care is about giving people the support that they need, joined up across local councils, the NHS and other partners. It removes traditional divisions between hospitals and primary care, between physical and mental health, and between NHS and local authority services.¹ The central aims are to integrate care across different organisations and settings; to improve population health; including addressing health inequalities; and to ensure the sustainability of services through collective action to enhance productivity and make the best use of available resources.²

The NHS Long Term Plan³ set out the ambition that all parts of England would be served by an integrated care system (ICS) from April 2021, building on the previous systems and the achievements of the sustainability and transformation partnerships. Legislation in the form of the Health and Care Act is subject to a White Paper currently, which is short on detail. However, there is a report, recently published by the King’s Fund⁴ which was commissioned by the Mayor of London which looks at the ICS developments in London. It is this report which we will examine in greater detail in order to shine a light on potential changes across the entire country. It is clear from many anecdotes that COVID-19 has made many of the collaborative developments which the ICS movement envisages, by default. Acute care has had to work in partnership with primary care networks and equally with local authorities and private care home institutions in order to ensure COVID care could work. There have been errors, not all has been smooth working, but equally with time, relationships have developed.