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
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.
- August 2021: National Evaluation of the Vanguard New Care Models Programme: Report of qualitative case studies
- June 2021: 10th National GP Worklife Survey
- June 2021: Exploration of the National Health Services Community Services Data Set Report
- March 2021: NHS Reorganisation
- Feb 2021: Integrated Care Systems interim report published
- Jan 2021: Stephen Peckham appointed to government select committee
- Dec 2020: Primary Care Networks: exploring primary care commissioning, contracting, and provision
- Nov 2020: Evidence on the impact of the Vanguard programme
- Nov 2020: Publication of ‘On Primary Care’
- Continuity of English primary care has worsened with GP expansions
- Mar 2018: PRUComm Annual Research Seminar [Event]
- Apr 2016: The future of commissioning [Event]
- Mar 2016: Examining the impact of the Health & Social Care Act: Examining developments in the English health system from 2013-2015 [Event]
- Feb 2013: Healthcare Commissioning Seminar: A summary
- Feb 2013 PRUComm research seminar on healthcare commissioning [Event]
- Jun 2011: How can evaluation contribute to health policy in England? [Event]