Following the legal formation of Integrated Care Systems as statutory bodies, and the abolition of CCGs, this article provides a general overview of ICSs and explains what the changes will mean for the UK health and social care sector.
We'll also review how ICSs may approach the digitisation of health and social care services.
Over the past eight years, the NHS has gone through a period of significant structural change, as set out in the NHS Long Term Plan. The Integrated Care Systems (ICSs) are a key part of the future direction for health and care, as they have now become the commissioners of local NHS services. This means that Clinical Commissioning Groups will be absorbed into the ICSs.
The aim of the ICS is to bring the previously separate NHS Trusts, local authorities and community services closer together to commission and deliver more effective patient-centred care for local communities.
What are Integrated Care Systems and what does it mean for the future of care?
There are two component parts of the Integrated Care System - the Integrated Care Board (ICB) and the Integrated Care Partnership (ICP) - which will now have statutory status and will collectively hold the ICSs legal powers and responsibilities. ICBs will be responsible for the NHS functions of an ICS, while ICPs will oversee their wider public health and social care services.
ICPs will involve the NHS, local councils, community and voluntary organisations, residents, people who use services, their carers and representatives and other community partners.
This is designed to ensure that areas of health and social care are brought together, with housing now being included, to address its impact on health inequalities. ICSs will have their own Integrated Care Boards that review the local care needs, establishing how their services will be planned and delivered.
Following the legal formation of ICBs, Clinical Commissioning Groups (CCGs) will be abolished, and their activities will be absorbed into the ICBs.
Why are Integrated Care Systems being established?
The changes have been put in place to ultimately help support the health and wellbeing of the whole local population. The Integration Whitepaper published in February 2022 stated that “A more joined up approach will bring public health and NHS services much closer together to maximise the chances for health gain at every opportunity.”
By integrating organisations from primary, secondary and social care, as well as community and housing services, healthcare bodies and local government can provide a stronger and more aligned health and social care system.
Local authorities will be able to determine which areas of care need the most focus, so they can effectively support access and implementation for service users. Organisations within each ICS area will also be able to collaborate on services and enhance communication, which will in turn help with productivity and potentially make the integrated service more cost efficient.
More importantly, service users themselves should also benefit from the delivery of a more joined up approach to care. Organisations working together can provide quick support for preventable conditions and greater consistency for those with long-term health needs, helping people to live healthy and independent lives.
Where will Integrated Care Systems be established?
There are now 42 integrated care systems, compared to the 106 CCGs that previously operated across England.
ICSs split down into smaller leadership categories, which determine where the different organisations contribute.
The first category being 'Systems' that cover populations of 1 - 3 million people, where overall planning and management will operate. These ‘Systems’ are then comprised of smaller 'Places', consisting of populations of 250,000 - 500,000 people. ICBs, local authorities and community services contribute to this category. Finally, we have ‘Neighbourhoods’ made up of around 30,000 - 50,000 people. This is where primary care organisations such as GPs, pharmacies and dentists operate.
When do Integrated Care Systems come into effect?
These structural changes in the NHS have been in planned since 2014. In terms of setting up ICSs, the legal formation date is 1st July 2022, when the current CCGs officially dissolve.
How are Integrated Care Systems expected to work?
Local governments will take accountability for the delivery of care in their area. As each area is different, having their own individual needs, no two ICSs will work exactly the same way. It will be up to the local organisations to enforce the choices made in their area.
However, it’s understood that ICSs will establish which areas of their health and care services need to be specifically resourced and how they will direct plans for those sectors. The newly collaborative organisations will deliver these priorities.
What could this mean for the digitisation of health and care?
The NHS Long Term Plan set out its ambition to utilise digital technology throughout the NHS, being widely discussed since its publication in 2019.
NHSX (now part of the NHS Transformation Directorate) noted that ICSs will be expected to “implement a shared care record that allows information to follow the patient and flow across the ICS to ensure that clinical and care decisions are made with the fullest of information”.
In terms of what we can expect from the digitisation of ICSs, NHSX has stated that they will continue to work towards the maturity of digitisation by helping local authorities with their digital records, cyber security, and skills: “We will do this by providing digital experts to support them, provide clarity on what will be developed as national capabilities and what will need to be done locally and develop a plan with them to improve their digital maturity towards the standards set out in What Good Looks Like.”
With widespread digitisation being expected from all sectors by 2024, many will wait with interest to see how the newly established ICSs utilise digital resources to benefit both health professionals, patients and service users alike.
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