This briefing sets out the findings from interviews, conducted over the summer and early autumn of 2022, with 25 chairs and chief executives of ICBs and chairs of ICPs, asking them to reflect on the creation of integrated care systems and their very earliest days as statutory entities. ICSs are partnerships that bring together NHS organisations, local authorities and others to take collective responsibility for planning services, improving health and reducing inequalities across geographical areas. There are 42 of them in England. They stem from a recognition that the traditional barriers between GPs, hospitals and community services, between physical and mental health, and between health and social care need to be broken down to provide care that is much better integrated. The briefing covers: developing new forms of accountability; recasting the relationship with NHS England and its regional teams; the role of national politicians and regulators; partnership working in local places; managing the change; making the new structures work. Given their history, there is a lot of variation in terms of how developed ICSs are, precisely how they are operating, and their relations with NHS regions and NHS England, which is itself undergoing a significant reorganisation. Not to mention differences in internal relations between local government, the VCSE sector and the NHS. There is much unfinished business. Now that ICSs are statutory, there are undoubtedly reports that, for some, the relationships with acute trusts are improving, that care is continuing to be better integrated, and that some parts of local government that were most sceptical have become more engaged. Compared to the early days of the sustainability and transformation plans, relations between local authorities and the NHS are, broadly speaking, much improved - even if it is, by definition, too early to tell how the interaction between the ICPs and the ICBs will play out in the long run.
(Edited publisher abstract)
This briefing sets out the findings from interviews, conducted over the summer and early autumn of 2022, with 25 chairs and chief executives of ICBs and chairs of ICPs, asking them to reflect on the creation of integrated care systems and their very earliest days as statutory entities. ICSs are partnerships that bring together NHS organisations, local authorities and others to take collective responsibility for planning services, improving health and reducing inequalities across geographical areas. There are 42 of them in England. They stem from a recognition that the traditional barriers between GPs, hospitals and community services, between physical and mental health, and between health and social care need to be broken down to provide care that is much better integrated. The briefing covers: developing new forms of accountability; recasting the relationship with NHS England and its regional teams; the role of national politicians and regulators; partnership working in local places; managing the change; making the new structures work. Given their history, there is a lot of variation in terms of how developed ICSs are, precisely how they are operating, and their relations with NHS regions and NHS England, which is itself undergoing a significant reorganisation. Not to mention differences in internal relations between local government, the VCSE sector and the NHS. There is much unfinished business. Now that ICSs are statutory, there are undoubtedly reports that, for some, the relationships with acute trusts are improving, that care is continuing to be better integrated, and that some parts of local government that were most sceptical have become more engaged. Compared to the early days of the sustainability and transformation plans, relations between local authorities and the NHS are, broadly speaking, much improved - even if it is, by definition, too early to tell how the interaction between the ICPs and the ICBs will play out in the long run.
(Edited publisher abstract)
Subject terms:
integrated care, governance, joint working, NHS, local authorities, accountability;
This long read seeks to place the report 'NHS staffing shortages: why do politicians struggle to give the NHS the staff it needs?' (Morgan, B., 2022) in a wider policy context, looking more broadly, to briefly consider the range of actions that the long-needed and often-promised comprehensive workforce plan for health and care needs to cover. For those leading on workforce away from national policy, this long read provides a brief overview of the key factors to keep in mind to act comprehensively across the range of levers to grow and support the workforce. The size and complexity of the workforce challenge in health and care means there will need to be concerted and sustained action across the system - on workforce planning, pay, training, retention, productivity, job roles and creating workplace cultures - that demonstrates staff are valued. While some action is needed in the long term, it is also possible to act in the short term to better support the workforce in the health and care system. Responsibility for some issues sits with national politicians and they need to act, for example, on funding and international recruitment, but leaders at all levels within health and care should address the workforce crisis as a collective responsibility, taking action nationally, regionally and locally. Most crucially, for any delivery commitments made nationally or locally, leaders must know that staff are available and well supported to deliver on those commitments.
(Edited publisher abstract)
This long read seeks to place the report 'NHS staffing shortages: why do politicians struggle to give the NHS the staff it needs?' (Morgan, B., 2022) in a wider policy context, looking more broadly, to briefly consider the range of actions that the long-needed and often-promised comprehensive workforce plan for health and care needs to cover. For those leading on workforce away from national policy, this long read provides a brief overview of the key factors to keep in mind to act comprehensively across the range of levers to grow and support the workforce. The size and complexity of the workforce challenge in health and care means there will need to be concerted and sustained action across the system - on workforce planning, pay, training, retention, productivity, job roles and creating workplace cultures - that demonstrates staff are valued. While some action is needed in the long term, it is also possible to act in the short term to better support the workforce in the health and care system. Responsibility for some issues sits with national politicians and they need to act, for example, on funding and international recruitment, but leaders at all levels within health and care should address the workforce crisis as a collective responsibility, taking action nationally, regionally and locally. Most crucially, for any delivery commitments made nationally or locally, leaders must know that staff are available and well supported to deliver on those commitments.
(Edited publisher abstract)
Subject terms:
NHS, social care, social care staff, health professionals, care workforce, integrated care, staffing levels, recruitment, international recruitment, planning, training, staff retention, wages, conditions of employment, professional role;
This paper seeks to explain the reasons for the NHS's chronic workforce shortages - the difficulties in workforce forecasting, the tendency to undertrain staff in the UK and the insufficiently strategic use of international recruitment - and why they have proven so politically challenging to address. The most recent statistics for England, from September 2022, report a vacancy rate among doctors of more than 7 per cent and a vacancy rate among nurses of almost 12 per cent. Just four months earlier, in May 2022, the same figures stood at less than 6 per cent and at 10 per cent respectively. The paper also sets out some possible solutions to help politicians overcome these challenges: having greater transparency in workforce forecasts; establishing an independent workforce-planning organisation; accepting the need for international recruitment. It bears repeating, however, that none of these solutions is a panacea and each brings its own challenges. If solving the NHS's workforce shortages was easy, it would have been done by now. This paper concludes with one final thought, on an issue that by necessity this short paper cannot do justice to: technology may force a change in the composition of the health workforce over the next 15 years in ways it has not changed before. The impact of such a change on NHS workforce policy - not least, the current system of collective pay bargaining - is hard to forecast, but is likely to be significant.
(Edited publisher abstract)
This paper seeks to explain the reasons for the NHS's chronic workforce shortages - the difficulties in workforce forecasting, the tendency to undertrain staff in the UK and the insufficiently strategic use of international recruitment - and why they have proven so politically challenging to address. The most recent statistics for England, from September 2022, report a vacancy rate among doctors of more than 7 per cent and a vacancy rate among nurses of almost 12 per cent. Just four months earlier, in May 2022, the same figures stood at less than 6 per cent and at 10 per cent respectively. The paper also sets out some possible solutions to help politicians overcome these challenges: having greater transparency in workforce forecasts; establishing an independent workforce-planning organisation; accepting the need for international recruitment. It bears repeating, however, that none of these solutions is a panacea and each brings its own challenges. If solving the NHS's workforce shortages was easy, it would have been done by now. This paper concludes with one final thought, on an issue that by necessity this short paper cannot do justice to: technology may force a change in the composition of the health workforce over the next 15 years in ways it has not changed before. The impact of such a change on NHS workforce policy - not least, the current system of collective pay bargaining - is hard to forecast, but is likely to be significant.
(Edited publisher abstract)
Subject terms:
NHS, health professionals, health care, staffing levels, recruitment, training, international recruitment, government policy;
This evidence submission draws on the King's Fund’s experience of working closely with local system leaders over several years to support integration and partnership-working, as well as our research on population health and integrated care in England and internationally. The King'sFund welcomes the National Audit Office's recent report assessing the starting point for ICSs and the challenges...
(Edited publisher abstract)
This evidence submission draws on the King's Fund’s experience of working closely with local system leaders over several years to support integration and partnership-working, as well as our research on population health and integrated care in England and internationally. The King'sFund welcomes the National Audit Office's recent report assessing the starting point for ICSs and the challenges and risks to their achieving their objectives. The King'sFund has strongly supported moves to better integrate care and improve population health over many years and has broadly supported the reforms introduced through the Health and Care Act 2022. However, we also recognise that these changes have been enacted at an incredibly challenging time and that making progress towards the objectives of ICSs in this context will not be easy. The National Audit Office report underlines the scale of these challenges and the significant risks to ICSs achieving the objectives that have been set for them. Key messages of this submission include: recognising the context ICSs are operating within; ensuring realistic asks of local systems; supporting the development of local system plans; an enabling national operating environment; balancing system priorities.
(Edited publisher abstract)
Subject terms:
integrated care, governance, systems leadership, planning;
A brief overview of place-based partnerships, which are collaborative arrangements between organisations responsible for arranging and delivering health and care services and others with a role in improving health and wellbeing. These partnerships are a key building block of the integrated care systems (ICSs) recently established across England and play an important role in co-ordinating local services and driving improvements in population health. There are currently around 175 place-based partnerships in England, typically covering populations of around 250–500,000 people (although this varies widely) - significantly smaller than the populations covered by ICSs. While ICSs can bring the benefits of working at scale to tackling some of the major strategic issues in health and care, smaller place-based partnerships within ICSs are better suited to designing and delivering changes in services to meet the distinctive needs and characteristics of local populations. The briefing attempts to address the following questions: What are place-based partnerships? What is the purpose of place-based partnerships? What is a 'place'? What are the expectations and requirements in national policy and guidance? How are place-based partnerships governed and led? What resources do place-based partnerships have at their disposal? How do place-based partnerships relate to health and wellbeing boards? What next?
(Edited publisher abstract)
A brief overview of place-based partnerships, which are collaborative arrangements between organisations responsible for arranging and delivering health and care services and others with a role in improving health and wellbeing. These partnerships are a key building block of the integrated care systems (ICSs) recently established across England and play an important role in co-ordinating local services and driving improvements in population health. There are currently around 175 place-based partnerships in England, typically covering populations of around 250–500,000 people (although this varies widely) - significantly smaller than the populations covered by ICSs. While ICSs can bring the benefits of working at scale to tackling some of the major strategic issues in health and care, smaller place-based partnerships within ICSs are better suited to designing and delivering changes in services to meet the distinctive needs and characteristics of local populations. The briefing attempts to address the following questions: What are place-based partnerships? What is the purpose of place-based partnerships? What is a 'place'? What are the expectations and requirements in national policy and guidance? How are place-based partnerships governed and led? What resources do place-based partnerships have at their disposal? How do place-based partnerships relate to health and wellbeing boards? What next?
(Edited publisher abstract)
Subject terms:
integrated care, joint working, place-based approach, collaboration, care providers, quality improvement;
Health and care systems can mitigate, reduce and prevent poverty’s effects on health, but to do this they need to be much better at sharing and acting on data. This long read sets out the data available, explores existing good practice, and what needs to happen next. The paper discusses the urgent case to prioritise action; the importance of data and metrics on poverty; using poverty data to inform awareness, action and advocacy; three key opportunities for ICSs to make progress on tackling poverty in the coming year as new structures embed. These are: including poverty measures in shared outcomes frameworks for ICSs; embedding poverty into ICSs’ population health strategies; collecting and sharing poverty data more systematically between partners, making use of ICPs. In spite of the limitations of the measures of poverty discussed in this paper, there are many examples of local teams using data to help them focus on responding to poverty and its effects, but more need to join them. This requires action from NHS England and other system leaders too, and data on poverty also needs to be baked into systems, structures and shared outcomes frameworks, alongside the lived experience of those suffering and at-risk from it.
(Edited publisher abstract)
Health and care systems can mitigate, reduce and prevent poverty’s effects on health, but to do this they need to be much better at sharing and acting on data. This long read sets out the data available, explores existing good practice, and what needs to happen next. The paper discusses the urgent case to prioritise action; the importance of data and metrics on poverty; using poverty data to inform awareness, action and advocacy; three key opportunities for ICSs to make progress on tackling poverty in the coming year as new structures embed. These are: including poverty measures in shared outcomes frameworks for ICSs; embedding poverty into ICSs’ population health strategies; collecting and sharing poverty data more systematically between partners, making use of ICPs. In spite of the limitations of the measures of poverty discussed in this paper, there are many examples of local teams using data to help them focus on responding to poverty and its effects, but more need to join them. This requires action from NHS England and other system leaders too, and data on poverty also needs to be baked into systems, structures and shared outcomes frameworks, alongside the lived experience of those suffering and at-risk from it.
(Edited publisher abstract)
Subject terms:
poverty, data collection, data analysis, integrated care, information sharing, joint working;
This report combines findings from a literature review, interviews with senior system and organisation leaders and workshops with frontline staff to create a deeper understanding of how interoperability can be successfully achieved by using technology so multiple organisations can work together - albeit with very different organisational cultures and professions - to achieve integration of care services and shared aims. Digital technologies are key to enabling collaboration between health and care partners in the new integrated care systems. In this report, we define interoperability as how people, systems and processes talk and work together across organisational structures and professions, supported by technology. Interoperability has three equally important aspects that are vital for success: good co-working relationships between staff so that they want to connect; technology that makes co-working as easy as possible; and an enabling environment (in which funding, capacity, skills, education and governance are aligned). Although traditionally seen as a technology problem, good technology is not enough for interoperability. To build and strengthen relationships, people need space and time away from their day-to-day responsibilities, and a structure that can help remove existing power dynamics. Relationships need to be continually developed and strengthened across organisations and professions for interoperability to progress. There need to be improvements in how digital technology functions, specifically: use and adherence to standards for how data is captured and shared; addressing the fragmentation of technologies; and simplifying the multiple approaches to data-sharing. Leaders need to work collectively to minimise power dynamics; staff need to be supported to lead change projects; and communications should reinforce a collaborative working culture. National NHS bodies should consider making changes to funding and funding timescales, using whole-system incentives and national initiatives to enable progress on interoperability.
(Edited publisher abstract)
This report combines findings from a literature review, interviews with senior system and organisation leaders and workshops with frontline staff to create a deeper understanding of how interoperability can be successfully achieved by using technology so multiple organisations can work together - albeit with very different organisational cultures and professions - to achieve integration of care services and shared aims. Digital technologies are key to enabling collaboration between health and care partners in the new integrated care systems. In this report, we define interoperability as how people, systems and processes talk and work together across organisational structures and professions, supported by technology. Interoperability has three equally important aspects that are vital for success: good co-working relationships between staff so that they want to connect; technology that makes co-working as easy as possible; and an enabling environment (in which funding, capacity, skills, education and governance are aligned). Although traditionally seen as a technology problem, good technology is not enough for interoperability. To build and strengthen relationships, people need space and time away from their day-to-day responsibilities, and a structure that can help remove existing power dynamics. Relationships need to be continually developed and strengthened across organisations and professions for interoperability to progress. There need to be improvements in how digital technology functions, specifically: use and adherence to standards for how data is captured and shared; addressing the fragmentation of technologies; and simplifying the multiple approaches to data-sharing. Leaders need to work collectively to minimise power dynamics; staff need to be supported to lead change projects; and communications should reinforce a collaborative working culture. National NHS bodies should consider making changes to funding and funding timescales, using whole-system incentives and national initiatives to enable progress on interoperability.
(Edited publisher abstract)
Subject terms:
integrated care, integrated services, collaboration, joint working, information sharing, information technology, digital technology, organisational culture, leadership;
This report examines Office for National Statistics (ONS) (provisional) data on Covid-19 and overall deaths since 2020, when the pandemic started, to 29 July 2022. The data relates to England, England and Wales, or the UK depending on data availability and relevance to the context. Overall, the number of people who have died from Covid-19 to end-July 2022 is 180,000, about 1 in 8 of all deaths in England and Wales during the pandemic. There have been several waves of Covid-19 deaths in England and Wales between 2020 and 2022, causing a surge in total and excess deaths compared with years preceding the pandemic. The first and second waves between mid-March 2020 and March 2021 caused the most deaths. Since then, the number of people dying from Covid-19 has been more moderate. The pandemic has resulted in about 139,000 excess deaths in England and Wales by 29 July 2022. This caused the mortality rate from all causes in 2020 and 2021 to increase to levels of about a decade ago. However, from January to June 2022, the all-cause mortality fell and was lower than in any year since 2001, very likely because of people who died prematurely in 2020 and 2021 as a result of the pandemic. Covid-19 changed the health profile of England's population radically by becoming the leading cause of death in 2020 and 2021. The number of people dying from Covid-19 exceeded the number of people dying from the most common killers in preceding years (eg, dementia and Alzheimer's disease, heart disease, stroke and lung cancer).
(Edited publisher abstract)
This report examines Office for National Statistics (ONS) (provisional) data on Covid-19 and overall deaths since 2020, when the pandemic started, to 29 July 2022. The data relates to England, England and Wales, or the UK depending on data availability and relevance to the context. Overall, the number of people who have died from Covid-19 to end-July 2022 is 180,000, about 1 in 8 of all deaths in England and Wales during the pandemic. There have been several waves of Covid-19 deaths in England and Wales between 2020 and 2022, causing a surge in total and excess deaths compared with years preceding the pandemic. The first and second waves between mid-March 2020 and March 2021 caused the most deaths. Since then, the number of people dying from Covid-19 has been more moderate. The pandemic has resulted in about 139,000 excess deaths in England and Wales by 29 July 2022. This caused the mortality rate from all causes in 2020 and 2021 to increase to levels of about a decade ago. However, from January to June 2022, the all-cause mortality fell and was lower than in any year since 2001, very likely because of people who died prematurely in 2020 and 2021 as a result of the pandemic. Covid-19 changed the health profile of England's population radically by becoming the leading cause of death in 2020 and 2021. The number of people dying from Covid-19 exceeded the number of people dying from the most common killers in preceding years (eg, dementia and Alzheimer's disease, heart disease, stroke and lung cancer).
(Edited publisher abstract)
This discussion paper looks at how local authorities in England improve the quality of adult social care, how they measure success, and what type of support they use to make improvements. We conducted 27 interviews with those involved in improving adult social care in local authorities, explored the adult social care improvement 'stories' in five local authorities and compared what we heard with established approaches and principles of quality improvement used in many sectors. We found examples of excellent work on improvement and local authorities drawing on the support offer that is provided through 'sector-led improvement', including: building capacity, for example, by borrowing staff with specific expertise from neighbouring areas; building capability, for example, by inviting staff to regular senior management discussions to expose them to quality issues; demonstrating leadership, for example, setting a clear strategic vision for quality improvement; creating a culture for improvement to thrive, for example, by creating a safe environment where staff feel comfortable raising concerns. The report uses the traditional stages of a quality improvement approach to illicit and map the improvement journeys described by local authorities. These include prioritising areas for improvement, exploring and understanding areas for improvement, implementing change and demonstrating impact. We saw huge variety in approach and a lack of a shared language or codified set of methods for improvement. At times, the absence of a shared quality improvement approach appeared to lead to improvement activity that was reactive, focused on short-term fixes and one in which the data and measurement were lacking. In this discussion paper, we don't make recommendations. Instead, we ask some questions, intended for the adult social care sector, about what the future should look like.
(Edited publisher abstract)
This discussion paper looks at how local authorities in England improve the quality of adult social care, how they measure success, and what type of support they use to make improvements. We conducted 27 interviews with those involved in improving adult social care in local authorities, explored the adult social care improvement 'stories' in five local authorities and compared what we heard with established approaches and principles of quality improvement used in many sectors. We found examples of excellent work on improvement and local authorities drawing on the support offer that is provided through 'sector-led improvement', including: building capacity, for example, by borrowing staff with specific expertise from neighbouring areas; building capability, for example, by inviting staff to regular senior management discussions to expose them to quality issues; demonstrating leadership, for example, setting a clear strategic vision for quality improvement; creating a culture for improvement to thrive, for example, by creating a safe environment where staff feel comfortable raising concerns. The report uses the traditional stages of a quality improvement approach to illicit and map the improvement journeys described by local authorities. These include prioritising areas for improvement, exploring and understanding areas for improvement, implementing change and demonstrating impact. We saw huge variety in approach and a lack of a shared language or codified set of methods for improvement. At times, the absence of a shared quality improvement approach appeared to lead to improvement activity that was reactive, focused on short-term fixes and one in which the data and measurement were lacking. In this discussion paper, we don't make recommendations. Instead, we ask some questions, intended for the adult social care sector, about what the future should look like.
(Edited publisher abstract)
Subject terms:
adult social care, social care staff, care workforce, quality improvement, intervention, good practice, case studies, staff development, organisational culture, recruitment;
A simple guide to how accountability flows across the national health and care system in England. The Health and Care Act 2022 and concurrent reforms to the public health system have introduced a range of changes and some simplifications to the landscape of national bodies in the health and care system. This guide explains the core functions of the national bodies with the most significant role in setting policy for and shaping the operation of the health and care system. These include NHS England, the Care Quality Commission, Healthwatch England, the Healthcare Services Safety Investigation Branch, and the National Institute for Health and Care Excellence. The guide also looks at how these organisations are held accountable for carrying out those functions and the extent to which central government can direct them.
(Edited publisher abstract)
A simple guide to how accountability flows across the national health and care system in England. The Health and Care Act 2022 and concurrent reforms to the public health system have introduced a range of changes and some simplifications to the landscape of national bodies in the health and care system. This guide explains the core functions of the national bodies with the most significant role in setting policy for and shaping the operation of the health and care system. These include NHS England, the Care Quality Commission, Healthwatch England, the Healthcare Services Safety Investigation Branch, and the National Institute for Health and Care Excellence. The guide also looks at how these organisations are held accountable for carrying out those functions and the extent to which central government can direct them.
(Edited publisher abstract)
Subject terms:
NHS, health care, governance, accountability, regulation, quality assurance;
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