Overview
Integrated care systems (ICSs) were created to increase collaboration in the health and social care sector and to enable the NHS, local authorities and other partners to take collective responsibility for improving health outcomes, reducing inequalities, delivering better value for money, and driving local social and economic development.
This research examines the development of ICSs by assessing their efforts to develop system-wide approaches to the recruitment, training and retention of staff. The findings are based on 24 in-depth interviews with local leaders in four case study sites plus a series of online workshops.
There are clear signs that progress is being made. We found evidence of ICSs beginning to build a ‘whole-system’ approach to workforce, in which local organisations work together more closely to tackle shared workforce issues and develop new solutions that better meet the needs of the local population. Our research identified several specific ways in which ICSs are enabling this to happen.
Despite these signs of progress, some of the more transformative work planned by ICSs is proceeding at a slower pace than intended as a result of the extremely challenging circumstances in which ICSs have been introduced. There is widespread concern that ICSs may not achieve their full potential unless more is done to create an environment conducive to their success.
The behaviours of national, regional and local leaders will make or break ICSs. There is an urgent need to ensure that accountability arrangements drive behaviours that reinforce system working rather than undermine it. Success depends on supporting people at all levels to think, plan and act in ‘system-focused’ ways.
Why we did this research
Integrated care systems (ICSs) are part of a decade-long shift in the English NHS from an emphasis on competition between organisations to a greater focus on collaboration and partnership working. This has been driven by a recognition that people using health and social care services increasingly need support from multiple parts of the system and that this support needs to be joined up and co-ordinated more effectively. ICSs bring together NHS bodies, local government, voluntary sector organisations and others to plan how they can collectively meet the needs of local people and help create the conditions for healthier lives.
Major national reforms gave ICSs statutory powers and budgets for the first time in July 2022. Two years on, we wanted to examine how ICSs have been developing since these reforms were introduced. In particular, we wanted to understand the extent to which ICSs are helping local leaders to develop ‘whole-system’ solutions to some of the substantial challenges facing the health and social care system. We chose to focus on workforce issues because these have a significant impact on patient care and often require a co-ordinated response from multiple organisations of the kind that ICSs were designed to enable.
What we did
We wanted to understand the development of ICSs through the eyes of people involved in the workforce agenda, exploring the successes and challenges they have encountered in attempting to work collaboratively on workforce issues such as the recruitment, retention and training of staff. We did so by selecting four ICSs as case studies and interviewing a range of people in each site. In total, we interviewed 24 people, including leaders with responsibility for workforce in integrated care boards (ICBs), provider trusts and the social care sector, as well as voluntary sector leaders and representatives from local Healthwatch organisations. We also tested and refined our findings through a series of online workshops.
What progress have ICSs made?
Overall, we found that ICSs have made progress in supporting local organisations to work together in a more collaborative way on workforce issues. However, this progress has been uneven and has not come easily. The two years since ICSs were given statutory status have been among the most challenging the NHS has ever faced, and it was evident in our research that these challenges have sometimes impeded ICSs’ efforts to develop innovative workforce solutions.
For example, several sites reported that the need to focus on resolving immediate issues, such as staff shortages, has meant that they have made slower progress on some of their more transformative partnership work aiming to redesign the workforce for the future. Managing the redundancy processes triggered by the national requirement to reduce management costs by 30% has consumed a significant amount of time for workforce teams in ICBs, while industrial action during 2023 and 2024 has meant that their counterparts in NHS trusts have often been focused on maintaining safe staffing levels.
We found that ICS leaders have had to navigate a series of tensions as they attempt to work in a ‘system-focused’ way (see Figure 1), adding to the complexity of the task they face.
By Cheryl Gowar, Chris Naylor, Julia Cream and Loreen Chikwira of the King's Fund