An overview of Integrated Care Systems (ICSs)

ICSs are partnerships that bring together public bodies and public healthcare service providers across geographic regions.

The main aim of ICSs is to centralise health and care across public organisations and governing bodies in order to better meet the needs of their populations.

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History and timelines of implementing ICSs

The concept of ICSs surfaced after a number of pain-points were voiced about the fragmented nature of decision-making and funding across Clinical Commissioning Groups (CCGs). Early attempts to address these pain-points included consolidation of CCGs, and the formation of Sustainability and Transformation Partnerships (STPs).

The NHS’s Long Term Plan went further, calling for integration of England’s healthcare provision into 42 ICSs. Every region of England is now covered by an ICS, each at varying levels of maturity.

In this transition, STPs are to be converted into ICSs, and CCGs are to be dissolved and rolled into relevant ICSs based on geography, with the objective of simplifying and maintaining one CCG per ICS region.

The image below illustrates the new structure. NHS England will remain the national governing body under which ICSs exist. CCGs, Primary Care Networks (PCNs), NHS Trusts, Local Authorities and Third-Party Providers will then exist within each ICS.

The Government's Health and Care Bill seeks to make ICSs statutory bodies from 1 July 2022, at which point the commissioning function of CCGs will effectively be replaced by ICSs.

💡 Stotles tip: The ICS transition landscape is evolving daily. For example, on 24 December 2021, the target date for implementation of ICSs as statutory bodies was delayed from 1 April 2022 to 1 July 2022. The reasons behind this are set out in the 2022/2023 priorities and operational guidance guidelines. As a result of on-going evolution, businesses looking to work with ICS bodies should keep a constant radar up for changes in key funding allocations and movements by NHS buyers and their suppliers.

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Levels of ICSs: Systems, Places & Neighbourhoods

A key goal of ICSs is to create a more centralised approach to health and care services for populations and patients.

There are three main levels to the structure of ICSs that aim to achieve this consolidation locally, as follows:

Systems

At the highest level are Systems, made up of the region’s entire group of health and care partners. Systems set the strategic direction of the ICS and serve population of 1 to 3 million people.

Examples of the functions that fall under Systems:

• Implementing strategic change
• Managing collective financial resources

Places

Then come Places, served by a set of local health and care providers who connect primary care networks (PCNs) to local organisations. Typically, Places exist at a council/borough level and serve populations of 250,000-500,000 people.

Examples of the functions that fall under Places:

• Integrating hospitals, councils and PCNs
• Developing models for ‘anticipatory’ care

Neighbourhoods

At the most concentrated level, there are Neighbourhoods, comprised of groups of GP practises working with NHS services to deliver more coordinated services. Neighbourhoods serve populations of between 30,000-50,000 people.

Examples of the functions that fall under Neighbourhoods:

• Integrating primary care and community services
• Strengthening primary care through PCNs across practices and health and social care

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NHS England has not explicitly defined the devolution of functions and resources across systems, places and neighbourhoods. Their recommendation, as stated in this Integrated Care Report, is that “it makes sense to plan, commission and organise certain specialised services at an ICS level, and to devolve a greater share of primary care funding and improvement resources on a more localised level.”

💡 Stotles tip: We expect CCG roles to transition into similar ICS functions, making previous relationships with CCG leadership teams helpful for suppliers approaching ICSs.

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Structure and decision making of ICSs

There are two key structural components of importance within ICSs:

The statutory side:

Each ICS System will be comprised of an Integrated Care Partnership (ICP) and Integrated Care Board (ICB), the overseeing body for each ICS.

• ICPs are responsible for developing an ‘integrated care strategy’ via an ICP committee (established jointly by local authorities and the ICB)
• ICBs are the new statutory organisations, bringing the NHS together locally, and leading the functions and budgets at a System and Place level

The delivery side:

The delivery side is comprised of the different organisations partnering to deliver patient care within each ICS (e.g., trusts, local councils, etc.)

• Partner organisations on the delivery side will be more "associated" with their trust or council than they are with the ICS body.
• There will be a larger number of parties involved on the delivery side than the statutory side.

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Once ICSs take legal shape in July 2022, we’ll learn more about how Systems, Places and Neighbourhoods work together across the UK.

Despite the current ambiguity, one thing is clear: transitioning to ICSs will result in a tremendous number of opportunities for technology suppliers to work with the public sector.

To find out more about the ICS transition, download our in-depth report; Digitising a changing NHS: The opportunities emerging for tech suppliers through the ICS transition, or sign up to Stotles today.

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