Nov 2019: Integrated Care Systems: What can current reforms learn from past research on regional co-ordination of health and care in England? A literature review

11 November 2019

The integration of health and social care at a ‘system’ level is currently a central NHS policy priority in England. The NHS Long Term Plan sets out how organisations are to continue to work together collaboratively as Integrated Care Systems (ICSs) and Sustainability and Transformation Partnerships (STPs) with the aim of improving co-ordination of local health and care services to encourage the better use of resources and through managing population health. In addition, seven new regional teams bring together NHS England and NHS Improvement at a regional level, intended to harmonise their operations for system-wide working.

This report presents the findings of a literature review examining research into previous intermediate tiers in the NHS. Despite undergoing continuous reinvention, an intermediate or regional tier has existed for most of the history of the English NHS, with statutory authorities responsible variously for long-term strategic planning, allocating resources, acting as market umpires, and overseeing delivery of local health services. The latest reforms mark a return of an intermediate tier, however, unlike previous health authorities, STPs and ICSs are not statutory bodies but instead exist as non-statutory partnerships. Without change to legislation, encouraging system-wide collaboration marks a major shift in policy direction away from the primacy of quasi-market competition.

Drawing on peer-reviewed academic research, historical analysis and commentary from academic and policy sources, this literature review addresses the following questions:

  • What functions were exercised by previous intermediate tiers of co-ordination in the NHS?
  • What organisational form did they take and how were they governed?
  • How have health and local authorities previously coordinated health and social care?
  • What key themes can we observe from past intermediate tiers to inform the ongoing reforms?
  • What challenges and issues might we anticipate Integrated Care Systems will face?

Through putting current reforms in their historical and geographic context, key themes and challenges are identified to inform policy makers, managers and others involved in the development of ICSs and STPs over the years ahead.

The report is part of the ongoing research by the Policy Research Unit in Health and Social Care Systems and Commissioning (PRUComm) on the developing architecture of system management in the English NHS – including Sustainability and Transformation Partnerships, Integrated Care Systems or their successors – commissioned by the Department of Health and Social Care.

Download the Executive Summary [pdf] >>

Download the literature review [pdf] >>