What are the pros and cons of the NHS shifting to an Integrated Care System (ICS)?

What are the pros and cons of the NHS shifting to an Integrated Care System (ICS)?

As the NHS outlines plans for sustainability and transformation partnerships (STPs) to develop into integrated care systems (ICS), what impact will this have on healthcare professionals and health service providers?

NHS England has identified 10 STP areas that are likely to become the first to shift to an integrated care system and include South Yorkshire and Bassetlaw, Frimley Health and Care, Dorset, Bedfordshire (including Luton and Milton Keynes), Nottinghamshire, Blackpool and Fylde Coast, West Berkshire, Buckinghamshire, Greater Manchester (devolution deal) and Surrey Heartlands (devolution deal).

In England, the language of ‘integrated care’ has been adopted to describe the NHS’s developing system that supports a more collaborative working relationship between organisations across the healthcare sector.

Integrated care systems replace previous accountable care systems (ACS) terminology, a concept derived from the United States, where accountable care organisations (ACO) were established under President Obama’s health reforms. Read more about NHS England’s belated decision to change the name of accountable care systems to integrated care systems here.

According to this House of Commons Library briefing paper, an integrated care system is “a model of healthcare organisation where a provider, or group of providers, takes responsibility for the healthcare provision of an entire population”.

While there is no fixed definition of an ICS, the organisation usually receives an annual, capitated budget to deliver contractually agreed health outcomes.

NHS England’s Five Year Forward View agenda mainly focuses on the wider integration of healthcare providers to offer a more cohesive service for patients. The current British Government sees implementing integrated care systems as a way to deliver this form of healthcare.

Some STP areas are on track to develop into integrated care systems, where organisations work together under a set budget to improve health and coordinate services for people who live in a particular area of the UK.

According to Kings Fund, “In part, these changes are all about managing the limited resources available to the NHS. But they are also about working together with services outside the NHS, like social care and public health, that have a really important impact on our health. This requires much closer working with local authorities”.

The pros of shifting to an integrated care model

There has been plenty of praise for the shift towards a more cohesive healthcare service because it will improve patient care and help the NHS to better manage their limited resources.

An integrated care system essentially encourages collaboration between different organisations within the healthcare sector, with the aim to integrate services and improve patient health in local areas.

For staff, improved collaboration has the potential to make it easier to work with colleagues from other organisations, while systems can better understand data about the health of local residents, allowing them to provide care that is tailored to individual needs, states NHS England.

As healthcare originations work alongside councils and draw on the expertise of local charities and community groups, the NHS will be able to help people live longer, healthier lives and allow them to stay out of hospital when they do not need to be there.

The cons of shifting to an integrated care model

While the new system seeks to offer a multitude of improvements, there has been some criticism about how the shift will impact patient care.

A report by NHS campaigners resource Stop the STPs claims an ICS model will be answerable to the health insurance company that hold the budgets and treatments available to the population covered by the ICS.

It criticises the new system, stating that imposing managed care pathways will “de-professionalise doctors and other healthcare workers, and destroy the individual patient-health worker relationships”.

“The health insurance company specifies what treatments are available (managed care) and which patients can access them (the ones who are cheapest to treat and who offer the best chance of financial recovery), as well as setting the overall annual population budget that the ACO has to stick to,” the report reads.

Read more about the implications of an ICS here.


What do you think of the shift towards an integrated care model? What impacts, positive or negative, do you think the new model will have on the UK’s healthcare system? Share your thoughts in the comment section below.

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