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The Integrated Care Systems' (ICS) cultural shift

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As we wait for a new Prime Minister to explain how we will keep the lights switched on this winter, does the NHS have an identity crisis?

In their inciteful blog last month looking at how ICSs were starting out[1] The King’s Fund posed several questions about how they might meet their objectives. Perhaps chief among these was whether providers and commissioners are working with a shared focus on outcomes.

To say that the competition, inherent in the commissioner-provider split, is well entrenched in the NHS is something of an understatement. It is equally true that UK healthcare can be notoriously slow to change direction. Is it possible to shift to shared goals, while bringing on board those players who have traditionally been kept at arms-length when it comes to policy?

NHS England have made their vision for ICSs clear:

“Partnerships will involve the NHS, local councils, community and voluntary organisations, local residents, people who use services, their carers and representatives and other community partners, with a role in supporting the health and wellbeing of the population.”[2]

The King’s Fund believe there is cause for optimism:

“…the will and commitment exist to improve population health and reduce inequalities through cementing new ways of working based on partnership and collaboration.”

So, where there is a will, is there a way? Perhaps. Although they go on to argue that:

“Collaboration between local services…requires changes to behaviours, attitudes and relationships among staff and leaders right across the system.”

Even the briefest glance at the opinion of some of the key stakeholders is sufficient to demonstrate the potential scale of the challenge. The BMA, for example, whilst ostensibly supporting the goal of collaboration, serves to demonstrate where some of the pitfalls might exist. The issue, so often the case in healthcare, is about where to put the emphasis:

ICSs must:

“Only be pursued with demonstrable engagement with frontline clinicians and the public, and must allow local stakeholders to challenge plans.”

So far, so similar. But they must also:

“Be given proper funding and time to develop, with patient care and the integration of services prioritised ahead of financial imperatives and savings.”[3]

As the King’s Fund reminds us quite correctly: It is not possible to legislate for collaboration.”

How is such collaboration to be achieved and, more importantly, sustained for the long-term, at a time of soaring inflation and crushing financial pressures?

The kind of top-down target and budget setting, along with the governance and oversight, traditionally employed at times of crisis, would seem completely at odds with the intended ICS ethos.

Squaring that circle is the challenge we now face.


[1] Are ICSs getting off to the right start? | The King's Fund (kingsfund.org.uk)

[2] NHS England » What are integrated care systems?

[3] Integrated care systems (ICSs) (bma.org.uk)