Integrated care systems are tackling health inequalities and improving health outcomes by integrating services and cross-sector partnerships. Hashum Mahmood, senior policy adviser for population health at NHS Confederation, shares how
The Health and Care Act 2022 established 42 integrated care systems (ICSs) in England, which are responsible for planning health and care services in local areas to better meet the needs of local communities. Three years on, are integrated care systems improving population health outcomes?
Why ICSs were formed
The formation of ICSs initiated a new era of integration and collaboration between the NHS and non-NHS system partners, including local government and voluntary, faith, community and social enterprises, replacing the previous culture of competition and fragmentation with a focus to deliver on four key aims:
- Improving population health and healthcare outcomes;
- Enhancing productivity and value for money;
- Tackling inequalities in outcomes, experience and access; and
- Helping the NHS to support broader social and economic development.
The role of the NHS Confederation
The NHS Confederation is the membership organisation that brings together, supports and speaks for the whole healthcare system in England, Wales and Northern Ireland. It supports local and national health and care leaders across its networks to innovate, transform and improve the nation’s health and wellbeing through promoting collaboration and partnership. Members are given a voice through its government influencing, policy media work/media and support to improve and learn from each other.
Through partnerships with academia and industry and ensuring statutory and non-statutory organisations, it conducts research and analysis to help its members deliver on their key aims and tackle longstanding challenges, such as reducing health inequalities and ensuring the sustainability of the health and care system.
How the NHS Confederation supports systems in tackling health inequalities
The NHS Confederation published a report in 2023/24 exploring health inequalities in funding across ICSs in England. When surveyed, ICS leaders ranked tackling inequalities as their primary ambition. In partnership with the Care Quality Commission, Clarity Consulting and Leeds Beckett University, we undertook a project to understand how systems approach efforts to tackle inequalities. The research found that leadership, governance, and relationships were key enablers of success in health inequalities. The most significant barrier systems reported overcoming was balancing long-term strategic priorities with short-term operational must-dos. Alongside the report, a practical toolkit was developed to support the implementation of high-impact changes to address health inequalities. This initial work has led to the development of further leadership programmes to tackle health inequalities.
Fragmented service structures to integrated systems
ICSs play a vital role in addressing key issues that matter to the public, such as primary care access, social care and urgent and emergency care. People today are living longer with multiple, complex long-term conditions and increasingly require support from many different services. A fragmented and uncoordinated service structure can negatively impact patient experience and outcomes. ICSs provide a model of joined-up support that better meets the physical and mental needs of the population. Given the holistic, social and relational approach, they can address the broader determinants of health, such as housing, financial resources and access to public services.
Whether it is keeping residents warm in Bedford or Growing Health Together in Surrey, case studies show how only by working together differently can residents get the best from their health and care services.
Focus for 2025
The government’s health mission tackles health inequalities at its core, aiming to ‘secure a fairer Britain where everyone lives well for longer.’ ICS leaders are actively involved in developing the government’s ten-year plan, due to be published in the summer of 2025. The government has a clear aspiration to develop integrated neighbourhood health and care services, moving the focus away from high-acuity settings to community-based approaches that provide proactive, personalised and multi-disciplinary care. The NHS Confederation is advocating for this radical transformation that will focus more on improving population health outcomes.
Why the need for ICSs
There is an urgent need to transform the health and care system to tackle systemic health inequalities and ensure health and social care delivery sustainability. Addressing these challenges requires an integrated response from all parts of the health and care system. Most ICS leaders are positive about their local systems’ progress against their four purposes. However, they are struggling with constricted fiscal realities and delivering short – and longer-term priorities is a delicate balancing act.
So, are integrated care systems helping to improve population health outcomes? Emerging evidence shows the shift to integration and collaboration in local systems is facilitating a move towards a more proactive and psychosocial model of health and care. However, there is still a long way to go.
