Financial pressures mean ICSs need to be given time to deliver

The committee, with new chair Steve Brine, is undertaking an inquiry into the autonomy and accountability of the new systems, which were introduced on a statutory basis in July. Asked what the systems needed to be successful, Patricia Hewitt, chair of Norfolk and Waveney Integrated Care Board and a former health secretary, called for a ‘moratorium on NHS reorganisations’.

‘This is a unique opportunity to work differently and get very different and better results for our residents, for the people we serve,’ she said. ‘Just don’t change it. Please, no more huge reorganisations. We do not need another legislative change on this one.’

Patricia Miller, chief executive of Dorset Integrated Care Board, said that time was needed to let the systems ‘bed in and work’. ‘Quite often, when we move to restructuring the NHS, we do not leave the system as it is for long enough to prove that it can deliver,’ she said. ‘We need to give this some time, because it will take time to develop the partnership. It will take time to start to see delivery of outcomes, particularly in health inequalities. It is not going to happen overnight.’

Chris Ham (pictured), co-chair of NHS England advisory body NHS Assembly, agreed that realism was needed about the timescale for realising the benefits. The National Audit Office recently suggested that it would take between three and 10 years to see the real benefits of integration right across England and Professor Ham rated this as a ‘fair assessment’.

But he also said the current pressures and financial context would inhibit progress. ‘ICSs, as statutory bodies, have been born in conditions of huge adversity,’ he said. ‘The financial challenges are unprecedented. The shortage of staff is a massive constraint on what ICSs are trying to do.

‘Neither of those is insuperable, but you might say that ICSs have been established not as going concerns because of the underlying deficits they inherited and are taking forward,’ Professor Ham added.

A longer timeframe would also be needed to judge ICSs against their core objectives of improving outcomes and tackling inequalities. ‘If we are serious about those being at the heart of what ICSs are doing, it is not going to be weeks and months,’ he said. ‘It is going to be, frankly, a number of years because of the nature of the work involved.’

David Nicholson, chair of Sandwell and West Birmingham NHS Trust and Dudley Group NHS Foundation Trust, also supported the 10-year time horizon. But he warned there were also short-term must-dos. ‘If we don’t sort out hospital flow and ambulance handovers relatively quickly, we are going to lose public confidence quite significantly.’ He said that if there was more money available for discharge it should go to social care to help them address capacity and social care staff pay.