The state of integrated care systems 2023/24: tackling today while building for tomorrow

Integrated care systems (ICSs) play an instrumental role in tackling the issues facing the health and care system today while building for tomorrow. This report examines progress made by local systems over the past year. Leaders of integrated care boards (ICBs) and integrated care partnerships (ICPs) reflect on their ambition for the future, the barriers and enablers that stand in the way and how the government and other national partners can better support them to succeed.   

Most ICS leaders are positive about the progress their local systems are making against their four purposes and will play a key role in delivering the government’s reform agenda, including improving productivity and maximising available resources, enhancing devolution, supporting the development of a neighbourhood health service and shifting resources into prevention and closer to people’s homes. 

However, they are struggling to marry their collaborative ambition with today’s fiscal realities. Delivering against short- and longer-term priorities is a careful balancing act, and performance management conversations focused almost entirely on finances are crowding out the longer-term transformation ICSs were established to deliver.

Over 90 per cent of ICS leaders surveyed are committed to shifting resource to allow more people to access more care closer to home. But they are struggling to match this ambition due to financial constraints. 

Over three-quarters of ICS leaders surveyed are concerned that financial challenges in the NHS and local government will impact their ability to deliver on their ambitions and negatively impact partnership working. In order to balance budgets today, they are being forced to cut back, delay or defer the programmes that will lead to tomorrow’s financial sustainability as well as improved outcomes. 

Only 40 per cent of ICS leaders surveyed believe accountabilities are well defined between ICBs and NHS England’s national team and there is clear variation in experiences of working with NHS England regional teams. 

But as the Darzi report highlighted, ICS leaders are held back by a lack of investment in capital as well as primary, community and social care services, performance standards focused on hospitals, unclear accountability arrangements, single-year budgets and politically driven short-term funding decisions. They need greater support from national government and arm’s-length bodies to deliver transformation.

ICS leaders welcome the opportunity to shape the future of the health and care system through active involvement in development of the government’s ten-year health plan, which they are pleased to see will take a more expansive ‘health’ (not solely NHS) focus.

On behalf of ICS leaders, this report makes several recommendations to national government and national bodies for consideration as part of the development of the ten-year health plan, including moving to multi-year funding settlements; changing to the payment scheme to support a focus on integration and prevention; evolving and embedding the new operating framework; ensuring oversight incentivises a balance between today and tomorrow; and giving ICBs levers to devolve decisions to place and neighbourhoods.