Introduction

This encompasses central government and its national bodies. In the context of this paper, this largely refers to the Department of Health and Social Care (DHSC). However, to address the wider determinants of health, a significant amount of joint working is needed across government departments, in particular with the Ministry of Housing, Communities and Local Government (MHCLG) and the Department for Work and Pensions (DWP). National bodies are established by government to oversee, regulate and support specific sectors or functions. The main national body referred to in this report is NHS England, which is being absorbed into DHSC – its sponsor department. NHS England is currently responsible for setting the overall strategy and outcomes that systems will be accountable for delivering.

Since the NHS was founded there has been a regional tier within the health and care system’s governance structure. From regional hospital boards to regional health authorities, strategic health authorities, and now NHS England regional teams, each iteration has aimed to improve the management and delivery of health services at the regional level. With the announcement that NHS England will be absorbed into DHSC and likely changing integrated care board (ICB) footprints, the regional tier is again being reformed.

An integrated care system (ICS) brings together the health and care organisations in a particular local area to deliver joined-up health and care services. Each ICS is made up of an integrated care board (ICB) and an integrated care partnership (ICP), along with NHS and social care providers and other partners, which will work in tandem to meet their four purposes. ICBs are the statutory NHS organisations with responsibility for planning health and care services for the area it covers. While there are currently 42 ICBs across England covering a population of around 1 to 3 million people, multiple mergers are anticipated following the 50 per cent cuts to ICB running and programme costs. In the future NHS operating model, an ICB will be expected to work with its local populations and local authority commissioners (increasingly mayoral footprints) to strategically commission joined-up health and care services and meet their four purposes. ICPs are collectively responsible for setting the integrated care strategy and bringing together NHS, local authority, voluntary, community and social enterprise (VCSE) and wider sector partners. 

Providers refer to a wide range of players, from those working at a larger population level (typically acute, mental health and specialist providers) to those working more locally (typically community, primary care and social care providers). They are responsible for delivering high-quality (safe, effective and positive patient experience) and efficient care. Increasingly, providers operating at place level work as the engine rooms for the integration of care services by bringing together all of the above at a local level.

Defining ‘place’ is complex, as it varies in meaning across the health and social care sector. In this paper we largely refer to place in relation to its 'health' functions delivered through place-based partnerships, as defined in the Thriving Places guidance. [1] Places should align with local service boundaries to streamline operations for providers and partners. Most places correspond to local authority footprints, often serving 250,000-500,000, though some can cover up to 1.2 million people. These partnerships are collectively viewed by health and care leaders as the engine rooms for integration, where a lot of the delivery for integrating care services happens. The future of place-based-partnerships may be impacted in some systems by cuts to ICBs budgets and at the time of writing it is unclear whether ‘place’ will exist as a geographical scale distinct from neighbourhoods.

 A more proactive, personalised and holistic model of care will be delivered at neighbourhood level. While we recognise the government language of a ‘neighbourhood health service’, this paper uses ‘integrated neighbourhood working’ as language that more closely reflects what is happening and different sector roles in the future of healthier neighbourhoods. Neighbourhoods vary in size, from a few houses to areas with 50,000+ people. People define their neighbourhoods based on local geography and history, while public services may use larger boundaries, based on statutory or service boundaries including primary care networks or district councils. While scale is helpful for enhancing resilience and sustainability for neighbourhood working, conscious effort must be made to work in and empower neighbourhoods that make sense to citizens.