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Explained: ICSs and the part they will play in the long term plan


By Valeria Fiore
Reporter
9 January 2019

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As part of the long term plan, published on 7 January, NHS England announced that ICSs will cover the whole of England by April 2021, evolving from the current network of STPs.

There are currently 8 ICSs and two devolved areas in England.

ICSs are similar to STPs, but they focus on a greater collaboration among local organisations. According to NHS England, ICSs favour the integration of ‘primary and specialist care, physical and mental health services, and health with social care’.

What does this greater integration mean, and what do we know so far about the role ICSs will play in the long term plan?

Improving population health

Prevention is one of the elements at the heart of the long term plan. Prevention is of course achievable through better planning, much of which will take place at ICS level.

The long term plan says: ‘During 2019, we will deploy population health management solutions to support ICSs to understand the areas of greatest health need and match NHS services to meet them.’

Through ICSs, commissioners will be expected to work with providers to effectively use resources, configure services and improve the health of the population they look after.

However, NHS England specifies that commissioners will keep making procurement and contract award decisions independently from ICSs.

Every ICS will have to streamline commissioning arrangements to trigger one set of commissioning decisions at system level. ICSs will also be required to introduce services to cut avoidable hospitalisation and prevent both mental and physical ill health.

The long term plan outlines that: ‘ICSs will become the level of the system where commissioners and providers make shared decisions about financial planning, and prioritisation.’

Key characteristics of an ICS

In the long term plan, NHS England spells out what ICSs should look like. They are expected to have:

  • a partnership board, with members from commissioners, trusts, primary care networks, local authorities, the voluntary and community sector and other partners
  • a non-executive chair, who will be locally appointed and nationally confirmed
  • ‘sufficient clinical and management capacity’ from their member organisation
  • a close relation with primary care, possibly through a named accountable clinical director of each primary care network
  • a greater emphasis by the CQC on partnership working and system-wide quality in its regulatory activity, to help providers account for their services and improve quality in their area
  • a commitment from all providers within their area to contribute to ICS goals and performance
  • ‘a clinical leadership aligned around ICSs to create clear accountability to the ICS’

ICS accountability and performance framework

This new framework will offer ICSs the possibility of following a ‘comparable set of performance measures’. It will come with an ‘integration index’ that will measure how each ICS is providing joined up and personalised care.

Financial reforms will be introduced ‘beyond 2019/20’ to help ICSs deliver integrated care, according to the long term plan.

ICSs will be given greater control over resources after they present a record showing strong financial and performance delivery, which will be assessed as part of the new ICS accountability and performance framework.

In order to help ICSs deliver service integration, NHS England envisages the introduction of local ‘alliance’ contracts or a new integrated care provider (ICP) contract, which will be made available for use following a public and provider consultation.

NHS England states that it expects the contract to be held by public bodies, although it said in the Draft ICP Contract: a Consultation that ICPs based on primary and community services could be led by a GP federation.

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