Caring for the carers

26 January 2021

In 2017, GGI and Care England jointly published a paper, System transformation and care homes, that explored the extent to which the adult social care sector was being engaged in the development of sustainability and transformation plans (STPs).

Our report found limited evidence that STPs adequately reflected the challenges facing the sector and argued that additional engagement across health and social care would be required to drive improvement.

Since that report, the risks to the adult social care sector have arguably only grown more substantial, with the COVID-19 pandemic in particular highlighting stark funding and workforce challenges.

Many of the statistics make uncomfortable reading, including more than 122,000 vacancies across England, a turnover rate of 30.8%, a quarter of staff employed on zero hours contracts, and as many as 1.4 million older people reportedly unable to access the support they require.

In a recently published review, the Health and Social Care Committee called for an increase in annual funding of up to £7 billion by 2023–24 to prevent the collapse of the sector. Many others, including Care England, have highlighted that, unless additional funds can be made available, there is a clear risk to the sustainability of the health and care sector.

ICSs and the care sector

Integrated care systems (ICSs) will have a key role to play in supporting the care sector, by taking a longer-term, more strategic view of population health needs and ensuring that resource allocation is aligned to patient need.

In our response to NHSE/I’s recent consultation on ICSs we argued that ICS working cannot just be seen as driven by the NHS, and that there is a general lack of understanding around care homes and domiciliary services within ICSs

In particular, we highlighted the significant opportunities for care homes and domiciliary services to support the realisation of wider ICS goals and called, as a matter of urgency, for greater involvement of the care sector in the development of ICSs.

To help ensure that ICSs realise this untapped potential, we have partnered with Care England again to revisit and update our 2017 report.

We also convened a roundtable event to reflect on the quality of engagement between ICSs and the care sector, as well as on examples of learning and best practice from around the country. The event attracted several ICS independent chairs and senior leaders from some of the UK’s largest care home providers, as well as prominent commentators and policymakers. It was a rich and fascinating session and we hope to publish our full findings shortly.

Key takeaways

In the meantime, we want to share some of the key takeaways from the session:

  • As we made clear in 2017, in tandem with increased funding, greater collaboration between health and social care services will be required to address the stark challenges that the care sector faces. During the roundtable, we heard that the pandemic has improved engagement between the NHS and the independent care sector. This impetus for change needs to be harnessed, not forgotten, to facilitate a fully integrated health and social care system.
  • ICSs across the country are adopting different approaches. It was acknowledged that the NHS has historically regarded social care and the voluntary sector as adjunctive services, and that within the NHS there is often a limited understanding of their value. Where care sector engagement has been effective, this has often been built around goodwill, relationships, and other informal factors rather than any consistent process. There is an opportunity with the development of ICS and more local place-based models to reframe such relationships, ensuring that the sector is properly engaged, early and on an equal footing.
  • In some places this is already beginning to bear fruit. For example, in north London close collaboration between NHS bodies, local authorities and the independent care sector on practical issues such as dementia care is helping to strengthen relationships and deliver improved outcomes.
  • Within the independent care sector there is significant variation in provider size and needs. This can present communication and engagement challenges. As much as possible, it would be beneficial for the care sector to engage with ICSs in a consistent and unified way. This could be achieved through peer-led networks, and several examples were given of where this was already taking place, including the South West Care Collaborative in Devon.
  • There was widespread acknowledgement of the significant financial and workforce issues that the care sector currently faces, and agreement that ICSs have an important role to play in supporting the sector. Attendees highlighted a number of initiatives that are already helping to shore up the health and social care workforce. These include staff sharing programmes, the upskilling of care home staff, and the greater utilisation of advanced nurse practitioners (and other similar roles) by care homes. Much more of this will be needed.
  • This sector is a key part of our heath and care system and one that can help ensure that services are as person-orientated as possible. As such, adult social care needs to be placed at the forefront of future policy planning. It can no longer remain an addendum to the NHS.


  • The NHSE/I paper outlines option for the establishment of ICSs. It is important that the care sector is engaged appropriately and early in this process.
  • In tandem, there is a need for those involved with ICSs to increase their understanding around care homes and domiciliary services.
  • There are many examples of innovative and effective partnerships between NHS bodies, local authorities and the independent care sector that should be reflected upon. These have increased in the course of the pandemic.

This is an issue that ICSs will want to improve their awareness of. We are keen to hear your views. We will be publishing our paper with Care England in February but if this Illumination prompts any questions or comments, please call us on 07732 681120 or email

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

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