Lucinda Allen, Senior Policy Officer, The Health Foundation and Phoebe Dunn, Interim Senior Research Fellow, The Health Foundation
As they near the end of their inaugural year as statutory bodies, the challenges facing the NHS’s new integrated care systems (ICSs) are vast. ICS leaders assumed responsibility for planning local services at the tail end of the COVID-19 pandemic during a period of political uncertainty, a cost of living crisis, ongoing industrial action and extreme strain on health and social care services.
ICSs have been set an ambitious ‘to-do’ list from government which includes improving care outcomes, tackling inequalities, enhancing productivity and helping the NHS support broader social and economic development. Among their many roles, ICSs are now responsible for promoting integration of health and social care services for people living in their area.
At the heart of the ICS experiment is the idea that collaboration – between hospitals, GPs, social care, and others – is needed to improve local services and tackle longstanding systemic issues. There is broad consensus that this is the right way forward, and ICSs build on a long history of partnership working and previous integrated care initiatives at a local level.
But the governance and design of ICSs risks social care and other community services being side-lined by more powerful
NHS bodies. Concerns have been raised – including by care providers and MPs – about how consistently and how well ICSs are engaging with the social care sector. And there is considerable variation in how local government is represented on integrated care boards.
Formal governance and accountabilities of these powerful boards are clearly important but policymakers and local leaders will also need to focus on how partners within ICSs work together in practice. Evidence shows that ‘softer’ factors – like trust, values and communication between partners, and commitment to collaboration – will shape how an ICS develops.
Here ICSs are coming from very different starting points. Historical context and existing relationships – good, bad or somewhere in between – between NHS, social care and other agencies vary from place to place, and will have a strong influence on how partners work together to improve services. Some areas, for example, may have had a head start through their involvement in previous integrated care initiatives, or because they have less complex organisational landscapes and fewer partners to build relationships and collaborate with.
It looks increasingly likely though, that national policy will act as the main factor curbing ICS progress. The past decade has seen low spending growth for the NHS, continued political neglect of adult social care and cuts to public health budgets. And there are stark workforce challenges across health and social care – chronic staff shortages, high turnover and burnout – which will limit the potential for ICSs to achieve the ambitious aims set for them by policymakers. Integrating health and care services will do little good without enough staff to provide them.
The government’s current plans do not go far enough in tackling these workforce problems, particularly in social care. The NHS was promised a ‘comprehensive workforce plan’ at the last autumn budget. While the NHS plan is yet to materialise, social care has no such promise. There has been some support for international recruitment by temporarily easing post-Brexit visa requirements for care workers. But government recently watered down already weak promises on wider measures to support the social care workforce, halving its planned budget for learning and development. And crucially, despite high levels of poverty among the workforce, there are no plans to improve pay for staff beyond increases to the national living wage.
If government is serious about supporting ICSs and the integration agenda, then it must take the workforce crisis in social care seriously. A short-term boost to international recruitment and feeble funding for training and development in social care won’t cut it. Alongside a workforce plan for the NHS, social care needs a long-term national plan to recruit, train and retain staff, including funding and action to improve pay, terms and conditions.