Adult social care and ICSs: time for action?

12 May 2021

Today GGI publishes a new report looking at the relationship between ICSs and the adult social care sector. The report highlights that there is much to be done.

Today marks the publication of GGI’s report The relationship between the adult social care sector and ICSs: time for action? This paper, written in partnership with Care England, explores the relationship between integrated care systems (ICS) and the adult social care sector.

Social care is at an inflection point. A growing funding deficit, more than 120,000 staff vacancies and a churn rate in the region of 30% is placing significant pressure on the sector. As a result, a reported 1.4 million older people are unable to access the care and support that they require.

A lack of knowledge and understanding about the sector within government has been a cited as a key challenge for the sector, resulting in a sustained lack of prioritisation. As the Nuffield Trust points out, this spilled over during the COVID-19 pandemic where:

Without a dedicated Director General between 2016 and 2020 and with a team of just 40, the Department of Health and Social Care’s lack of capacity to deal with a crisis on the scale of COVID-19 was plain.

This is something that GGI has written and spoken about frequently. Our 2017 report with Care England argued that unless there was greater involvement of the adult social care sector in STP arrangements the sector would continue to struggle.

Our new report is based on a series of interviews with ICS chairs and a roundtable event hosted earlier in the year. In it, we continue to make this case, arguing that opportunities for reform and renewed engagement between adult social care, the NHS and ICSs must be taken to put the sector on a firmer footing.

What is now needed?



  • The Five Year Forward View had set out the ambition to introduce new models of care to drive integration across health and social care.

  • STPs were finding their feet and there was limited engagement with the care sector.

  • Significant funding pressures abound in the care sector. By one estimate, as many as half of care home providers were at risk of bankruptcy.

  • Across the sector there were 90,000 social care vacancies and staff turnover of 27%.

  • There was an increasing ambition to use technology to improve services and efficiency.

  • Subsequent national policy, including the NHS Long Term Plan, has reaffirmed the direction of travel for health and social care.

  • NHS England has set an expectation that all STPs will become ICSs by April 2021, with the recent Government White Paper looking to put them on a statutory footing.

  • Today, engagement with the care sector has grown, with room for further improvement.

  • Funding pressures remain and, in many places, have increased.

  • Staff vacancies have swelled to 122,000 and the turnover rate to 30.8%.

  • The challenges faced by the care sector are laid bare by the COVID-19 pandemic. However, this has reinforced the need to utilise technology as fully as possible.

As the above graphic illustrates, in the four years since our previous report, there has not been a significant change in the outlook for adult social care.

More engagement needed

Attention and, in particular, solutions are desperately required. Beyond a called for increase in funding, greater engagement of the adult social care sector within ICSs is one mechanism through which the interests of the sector can be bolstered.

We know that the pandemic has strengthened collaboration and improved relationships across the health and social care sector. And, with the recently published Department of Health and Social Care white paper proposing both a new duty to collaborate for all NHS providers, as well as the development of an ICS health and care partnership board to sit alongside the NHS focused board, there is now significant scope for a rethink of how the sector engages with adult social care moving forward.

Golden opportunity

Our report argues that this is an opportunity that cannot be missed. In our engagement activities, we consistently heard that this momentum now needs to be built upon and incorporated into ICS planning, governance and development.

This includes giving thought to the most appropriate way to engage with, and meaningfully involve in decision-making processes, the myriad of adult social care providers; acknowledging the vital role that adult social care providers play as anchor institutions and resourcing them as such; and truly working in partnership to address some of the wicked issues that the sector currently faces.


  • Our new report updates our previous research on the extent to which ICSs are appropriately engaging with the adult social care sector.
  • As in 2017, we argue that there is considerable room for improvement. It is clear, however, that developing ICS arrangements do present an opportunity to reframe relationships between the NHS and adult social care organisations in a more constructive manner.
  • To realise this, it is paramount that the care sector is engaged appropriately and early in this process. At the same time, there is a need for government, as well as those involved with ICSs, to increase their understanding around care homes and domiciliary services.

If you have any questions or comments about this briefing, please call us on 07732 681120 or email

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Prepared by GGI Development and Research LLP for the Good Governance Institute.

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