Integrated care systems undermined by current health and care crisis

 In a report – Introducing integrated care systems – issued today, the Public Accounts Committee is critical of the progress made on workforce, estates and finance. ‘Until the Department has properly addressed these issues, including a trend towards ‘paralysis by analysis’ in formulating plans, it is difficult to see how ICSs can fulfil their potential,’ it said. 

And it added accountability arrangements for ICSs appear under-developed, with a ‘concerning lack of oversight’ and a lack of leadership from the Department on how the NHS and local government should work together.  

And it criticised the lack of clarity about what specific benefits ISCs are meant to deliver, adding that significantly improving population health outcomes could take another three to 10 years with such long-term objectives affected by short-term pressures on the NHS.

The report called for information about the expected benefits and barriers have been overcome between the NHS and social care to support integration of objectives and funding. It also urged the Department to publish its response to a consultation on prevention that closed in 2019.

It identified workforce shortages as a long-standing issue, which has worsened during the pandemic and can threaten patient safety. The government has now confirmed that its workforce implementation plan will be published this year, but the committee pointed out that more information is needed on social care vacancies and what has been achieved from the £500m committed to workforce reform in 2021 and the £500m fund to address delayed discharges announced last September. It also wanted to see a justification from the Department if staffing levels are intended to remain significantly below comparators in the OECD.

It said the DHSC was showing ‘a worrying lack of leadership’ around the tension created by the differences in funding and accountability between the NHS and social care and how problems in joint working can be resolved. It called for guidance to be published on this within six months.

On estates, it said that ICS were contending with the legacy of an ‘increasingly decrepit’ infrastructure, with an ‘eye-watering £9bn in backlog maintenance. And it called for greater clarity on whether ICSs will be able to keep the full amount raised by any asset sales and for the promised capital strategy to be published by the Department early in 2023, with an analysis of need and how this is to be addressed.  The Department and NHS England should publish annual progress updates.

It highlighted dentistry as an area ‘in crisis in some parts of the country’ with more acute dental problems developing through NHS England’s failure to ensure people can access routine care. It asked for NHS England to provide information on funding and what services it will cover.

Dame Meg Hillier (pictured), Public Accounts Committee chair, said: ‘Far from improving the health of the nation, staff shortages and the dire condition of the NHS estate pose a constant risk to patient safety. But government seems paralysed, repeatedly rethinking and delaying crucial interventions and instead coming up with plans that do nothing to address the fundamental problems of funding and accountability. 

 The ICS reforms have potential, but there is no clear responsibility for ensuring that social care is properly integrated with healthcare or that patients will see the difference on the ground,’ she added. ‘Changes will not succeed if they are imposed on the NHS in its current state. Government needs to get a grip on the wider, full-blown health and social care crisis it allowed to develop from long before the pandemic.’

NHS Providers’ director of policy and strategy Miriam Deakin said it was ‘too soon’ to pass judgement on whether ICSs were working. ‘To succeed, ICSs, the government and national policymakers must do all they can to improve the wider factors of good public health – including housing, education, employment and inequalities,’ she said.

‘Every part of the system from top to bottom must be given the right incentives and held to account on delivery of better outcomes for communities. To fulfil their potential ICSs must be true partnerships with the NHS, local government, social care services and voluntary and community sector organisations.’

She continued: ‘The government can back this joined-up working by helping to boost staff recruitment and retention with a long-term, fully funded national workforce plan, ensuring that the whole health and care system, including community services and social care, has the capacity and funding to deliver first-class care.’