Integrated Care Systems: What can current reforms learn from past research on regional co-ordination of health and care in England? A literature review ? Executive summary

Lorne, Colin; Allen, Pauline; Checkland, Kath; Osipovic, Dorota; Sanderson, Marie; Hammond, Jonathan and Peckham, Stephen (2019). Integrated Care Systems: What can current reforms learn from past research on regional co-ordination of health and care in England? A literature review ? Executive summary. London School of Hygiene and Tropical Medicine, UK, London. (Unpublished)



This report is part of the research of the Policy Research Unit in Health and Social Care Systems and Commissioning (PRUComm) on the developing architecture of system management in the English NHS – including Sustainability and Transformation Partnerships, Integrated Care Systems or their successors – commissioned by the Department of Health and Social Care.

Five years since the publication of the Five Year Forward View (NHS, 2014), the integration of health and social care at a ‘system’ level remains a central NHS policy priority in England. The NHS Long Term Plan (NHS, 2019a) further set out how organisations are to continue to work together collaboratively across bounded geographic territories with the aim of improving co-ordination of local health and care services to encourage the better use of resources and through managing population health. Without change to legislation, encouraging system-wide collaboration marks a major shift in policy direction away from the primacy of quasi-market competition.

Forty-four non-statutory Sustainability and Transformation Partnerships (STPs) of NHS commissioners and providers, local authorities, and in some cases, voluntary and private sector organisations have been formed across England. Fourteen of the more ‘mature’ partnerships have since been designated Integrated Care Systems (ICSs) to be granted increased autonomy, providing greater freedom over how they manage resources collectively. There are usually three spatial levels of organisation within each STP/ICS: ‘neighbourhoods’ covering a population of roughly 30,000 – 50,000; ‘place’ between 250,000-500,000 people and STP/ICS ‘system’ level between 1 million – 3 million. In addition, seven new regional teams bring together NHS England and NHS Improvement at a regional level, intended to harmonise their operations for system-wide working.

Despite undergoing continuous reinvention, an intermediate tier has existed for most of the history of the English NHS, with statutory authorities (at times, several layers of authorities) responsible variously for long-term strategic planning, allocating resources, acting as market umpires, and overseeing delivery of local health services. The latest reforms mark a return of an intermediate tier, filling a vacuum left behind by the abolition of Strategic Health Authorities (SHAs) in 2013. However, unlike previous health authorities, STPs and ICSs are not statutory bodies, but instead exist as non-statutory voluntary partnerships despite being effectively mandated by NHS England.

This report presents the findings of a review of literature on previous intermediate tiers in the NHS. Drawing on peer-reviewed academic research, historical analysis and commentary from academic and policy sources, it examines their functions and responsibilities, how they operated in practice and their interaction with local government. Putting current reforms in their geographical and historical context, we draw out lessons for the challenges and opportunities STPs and ICSs may encounter in the years ahead.

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