The next three steps for an ICS

18 July 2022

In the build-up to the formal go-live date for integrated care systems on 1 July, many minds across the NHS and the wider public sector were focused on the complex task of ensuring that the structures and processes of integrated care systems were in place.

Now the big day has come and gone, it’s time for England’s 42 ICSs to focus on the bigger challenge of establishing the right mindsets and behaviours for effective systems working, developing proposals for ‘end-state’ and putting in place the required capacity and capabilities.

In short, the structure is built – but the heavy lifting is still to come.

Culture change

GGI believes there are three key interrelated components of this cultural change: the development of integrated care boards, building place-based partnerships and provider collaboratives, and enabling NHS trusts to work within systems.

  1. Integrated care board development – Members of the new integrated care boards (ICBs) will more often than not be experienced board members, but none will have served on a board quite like an ICB, where colleagues are from different organisations, with different priorities, approaches and expectations. ICB members will have to learn to recalibrate the way they work to fit their new role of overseeing a system rather than managing a single organisation. Their top priority now is to make a positive impact on their system’s ability to influence the health outcomes of the populations they serve. To succeed, they must become more radical, innovative and transformational. They must accept that the individual system partners will be doing most of the work and that successful ICB functioning is more about facilitation than contract and performance management. A comprehensive and well-thought-through programme of organisational development is required to develop and enable the system leadership and coaching role that is now needed. ICB functional teams need to be reviewed to ensure that they are fit for purpose in this new world, and resources may need to be transferred to system partners.
  2. Place-based partnerships and provider collaboratives – Most of the work of integrated care will take place at the local level and there has already been a considerable amount of work done to establish effective place-based partnerships and provider collaboratives. Now the time has come to develop a clear roadmap for the end state of place-based partnerships and provider collaboratives, including specific roles and responsibilities that will be delegated from the ICB. GGI is already working with system teams running organisational development programmes to identify and embed the cultures and behaviours needed to make a success of these partnerships. This is designed to enable them to take on significant responsibility for transformation of services and to fulfil their key functions of understanding and working with local communities, coordinating services around people’s needs, addressing the social and economic factors that have a bearing on health and wellbeing, and supporting the quality and sustainability of local services.
  3. Helping NHS trusts to operate within a system – The final focus area for development work is to support the changes that NHS trusts need to make to succeed as part of a system. Trusts must develop five-year forward plans jointly with their ICB and other trusts. They are now bound by law to carry out this joint planning, and to consider the wider effect of their decisions. Some trusts would say that they are already system partners, but our experience would suggest that some have failed to grasp the full significance of both the opportunities and the risks they face. Trusts have an opportunity to play a major role in place-based partnerships and provider collaboratives but must adjust their approach to reflect the change from being accountable for the quality of services provided to patients, to being accountable for the health and wellbeing of their local communities. This fundamental change, becoming both a provider and a commissioner, has significant implications for the role of the board, and the capacity and capabilities that are required.

A ‘whole system’ approach

Crucially, all three of these elements – ICB board development, place-based partnership development, and development for NHS trusts working in systems – must be developed together and seamlessly dovetail for the system model to succeed. It won’t work, for example, if an integrated care board delegates extensively to place but still remains itself as a big organisation, or if NHS trusts taking on lead roles do not have the capacity or capability to fulfil their new range of duties and accountabilities.

In our work GGI advocates for a ‘whole-system’ approach to developing ICS governance arrangements – no component will be effectives unless it fits in and works well with the overall system architecture. We believe that future success will depend on a common organisational development programme across all three of these system elements. All must be aligned around a common culture and behaviours, bound by agreed governance, and work together to achieve a shared purpose.

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

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