As we move towards Integrated Care Systems (ICSs) in England, we will be discussing the key changes in the NHS which are shaping the provision of current and future health and social care. In this blog, we will be exploring what ICSs are, their core purpose and ambitions and how data is going to be a key asset to improving patient outcomes in this new and ‘localised’ service delivery model.

What are Integrated Care Systems?

ICSs have evolved from Sustainability and Transformation Partnerships (STPs) and will guide how health and care services are planned, paid for and delivered. ICSs are a key part of the NHS long-term plan and provide geographical regions with more autonomy to manage the health of their respective populations.

As of November 2020, there are currently 18 ICSs which are operational and cover around 50% of England’s population. The national aim is to have all 42 ICSs formed by April 2021 – a bold yet achievable challenge!

At its core, integration of care means joining up hospital and community-based services, physical and mental health and health and social care. Providers and commissioners of NHS services will integrate with local authorities and partners to collectively plan and collaborate on service delivery. Involving local authorities in these decisions means there is potential to drive improvements in population health by tackling the wider determinants of health that drive longer-term health outcomes and inequalities.

What is the structure of an ICS?

In recognition that it might be challenging to deliver changes in services to meet the distinctive needs and characteristics of local populations, the delivery of health care within an ICS is through smaller partnerships centred around more local areas and populations. A ‘three-tiered’ model has been designed:

• System: the geographical region in which a single ICS operates. The roles of the System are to manage the overall strategy, drive economies of scale, identify and share best practice to reduce unwarranted variations in care.
• Place: a town or district within an ICS, usually with the same boundaries as a local council or borough. Changes to clinical services, including targeting population health, will be designed and delivered at a Place level. Providers may work together to join up their services through alliances or more formal contractual arrangements.
• Neighbourhood: Groups of GPs and community-based services, e.g., primary care networks (PCNs), who work together to deliver care and support, particularly to patients with the most complex needs.

Autonomy of Systems creates a mechanism for geographical regions to address their own health challenges, which will hopefully tackle health inequalities across England. For instance, yearly healthcare costs in England relating to cardiovascular disease (CVD) are estimated at £7.4 billion, with an annual cost to the wider economy of £15.8 billion, but there is known variation in the mortality outcomes in CVD - the death rate in Manchester is four times higher than that for Mid Suffolk. A nationwide CVD policy may not address the regional challenges and therefore a more localised strategy at a System level might be the best way to tackle some of the geographical health inequalities.

How will data and technology improve outcomes for patients under an ICS?

As the NHS moves more comprehensively towards an integrated care model, existing data and digital transformations combined with an “improvement mindset” could result in tangible differences to a patient’s experience and their access to best available care. Data is all around us in healthcare and we must continue to use it wisely to improve the outcomes for patients.

NHS resources are scarce. It is therefore imperative that inefficiencies are ironed out and we create a model which avoids ‘waste’. Using available data, it is possible to reduce ‘waste’ across a pathway by streamlining the internal administration process, scheduling of theatres and consultant rostering or even identifying pathway variation across a System. We have seen this happen most recently with the response to the current COVID-19 pandemic – harnessing available data meant we could map patient location to treatment centre, then identify a more efficient process to allow patients to receive care closer to home, and tertiary centres to treat the most critical patients.

NHSX are a joint unit to drive the digital transformation of care, which has been accelerated by COVID-19. Technology means an outpatient appointment is often no longer the fastest or most accurate way of providing specialist advice on diagnosis or ongoing patient care. NHS services will be redesigned so that over the next five years patients will be able to avoid up to a third of face-to-face outpatient visits, removing the need for up to 30 million outpatient visits a year. The digitalisation of the service will also allow PCNs to proactively identify ‘at-risk’ patients from healthcare records and deliver services based around either prevention rather than treatment or earlier detection and intervention to treat undiagnosed disorders.

Key takeaways

• At its core, ICSs are attempting to bring a broad set of organisations together to deliver healthier populations at a local level and to reduce the cost per capita of health and social care
• ICSs have the potential to address inequalities across Systems, Places and Neighbourhoods and access all members of society, including hard to reach communities, to make these local communities best places to live and work and reduce geographical health inequalities
• Systems and Places within ICSs are best placed to collaborate with their local organisations and therefore can deliver services in the key areas/priorities
• Harnessing available data and moving digital can result in improved outcomes for patients and improve the efficiency of service delivery
• For more information on how Integrated Care Systems will impact market access strategies and programmes, please feel free to contact Steven Ferguson or Vishal Manro.