Last Updated on 20/10/2023 by Samantha Lewis
As the Department of Health & Social Care (DHSC) introduces new reforms in its efforts to better integrate the health and social care system in England, there will be increasing use of a range of unfamiliar terminology: Integrated Care Systems (ICSs), Integrated Care Boards (ICBs), and Integrated Care Partnerships (ICPs). To help provide clarity, the British Healthcare Trades Association (BHTA) has produced this simple guide, highlighting and defining some key terms.
Integrated Care System (ICS): Broad, regional, health & social care delivery area/operating unit that brings together providers/commissioners of NHS services, Local Authorities, and other stakeholders to collectively plan and deliver health & care in an integrated fashion, joining up hospital and community-based services, physical and mental health, and health and social care; all parts of England are now covered by one of 42 ICSs.
Integrated Care Board (ICB): Legally constituted leadership & governing body for an ICS.
Integrated Care Partnership (ICP): Planning body of an ICS, operating at the “Place” level (see ICSs – Mission & Components below).
As part of the Health & Care Bill 2021 – and in line with the January 2019 NHS Long-Term Plan – the government is reforming the way health & care services are planned, delivered, and funded by shifting to Integrated Care Systems (ICSs). ICSs have grown out of organic efforts by some NHS Trusts and Clinical Commissioning Groups to work more collaboratively over the last two decades in Sustainability and Transformation Partnerships (STPs), and some have already begun operating, voluntarily, as ICSs.
The government is now placing ICSs on a statutory footing, meaning they will have basis in legislation, with formal powers and accountabilities. As part of this process, DHSC, NHS England, and NHS England Improvement are beginning to publish guidelines and policies setting out how ICSs and their constituent/related parts will work.
ICSs – their evolution, structure, and future operations – are a very complex topic, and forward-looking analysis of their development and operation is made more difficult by the fact that their ways of working and governance structures are in constant flux. By far the best all-in-one-place, plain-English summary of ICSs is a May 2021 “explainer” published by The King’s Fund – Integrated Care Systems Explained – Making Sense of Systems, Places and Neighbourhoods – although even its analysis is being overtaken by events as ICSs (and the government’s guidance for them) continue rapidly to evolve.
Integrated Care System (ICS): A partnership between the organisations (NHS, Local Authorities, social & care bodies, and other stakeholders) that meet health and care needs across an area, which allows for planning and coordination in ways that improve population health and reduce inequalities between different groups.
The core purpose of an ICS is to:
ICSs operate, broadly speaking, at three levels:
Integrated Care Board (ICB): Responsible for the commissioning of healthcare services in an ICS area, bringing together the NHS, Local Authorities, and other stakeholders to improve population health and care. If the Health & Care Bill 2021 is passed into law:
Integrated Care Partnership (ICP): A broad alliance of organisations and representatives concerned with improving the care, health, and wellbeing of the population, jointly convened by Local Authorities (LAs) and the NHS. The ICP will:
For a brief (7-page) overview of the different levels of management that make up an ICS – including their core functions, the rationale behind them, and how they will work together – please see the NHS’ June 2019 guidance document Designing Integrated Care Systems (ICSs) in England. For more detail on ICSs, ICBs, and ICPs, please see the NHS’ June 2021 guidance document Integrated Care Systems: Design Framework.
Summary of Integrated Care Partnership (ICP) Engagement Document: Integrated Care System (ICS) Implementation (Government guidance, published 15-Sep-21)
The top-line takeaway of this document is that – howsoever it purports to be guidance – it operates under DHSC’s clear and repeated caveats that the government does not foresee much detailed guidance at all with regard to ICPs or their operation, so as to preserve maximum flexibility at local levels, viz:
That said, DHSC sets out several expectations for ICPs.
ICPs will:
ICPs’ central role is in the planning and improvement of health and care. They should support place-based partnerships and coalitions with community partners which are well-situated to act on the wider determinants of health in local areas.
ICPs will be required to develop an integrated care strategy to address the broad health and social care needs of the population within the ICP’s area, including determinants of health such as employment, environment, and housing issues.
ICPs are expected to highlight where coordination is needed on health and care issues and challenge partners to deliver the action required.
The greatest detail in the guidance is around examples and suggestions – not requirements or prescriptions – as to how DHSC expects ICPs to “add value” in the areas that form DHSC’s five key expectations of ICPs:
DHSC expects that all ICSs will have at least an interim ICP up and running when statutory ICBs commence as planned in April 2022, subject to the passage of the Health and Care Bill 2021 through Parliament.
In closing, DHSC “now ask all 42 integrated care systems to take the following five steps, [and for] NHS ICB Chairs Designate to ensure these steps are carried out in their system, in partnership with local government”:
The guidance closes with an FAQ document.