Current projects
03 January 2019 – 31 December 2021
Contact: Professor Pauline Allen
The aim of this study will be to investigate the further development of STPs, ICOs and ICSs or their successors under the NHS Long Term Plan ‘LTP’ in order to find out how effective these new forms of collaboration are in achieving their goals, and what factors influence this.
At local system level there is an increasing emphasis on developing integrated systems such as ICSs where commissioners and providers take on collective responsibility for resources and population health. In addition to specific local aims, ICSs are intended to: ensure that care is delivered in appropriate and accessible settings; use limited local resources efficiently; and demonstrate improvement in population health. ICOs are envisaged as a further stage of development of ICSs, where a single organisation will be formed out of the current range of stakeholder organisations. System integration is a key goal of NHS policy and will continue to be salient for the next few years as the details of the relevant structures and governance arrangements develop. Understanding system management and oversight and exploring the role of commissioning and incentives in such systems will be important for supporting policy development and practice.
- To understand how local leadership and cooperative arrangements with stakeholders (statutory, independent and community-based, including local authorities) are governed in the light of the ICS governance recommendations in the LTP. How statutory commissioning organisations including local authorities are facilitating local strategic decisions and their implementation; and whether different types of commissioning function are evolving at different system levels.
- To understand whether ICSs and ICOs or their successors are able to allocate resources more efficiently across sectoral boundaries and bring their local health economies into financial balance.
- To understand how individual organisations are reconciling their role in an ICS or its successor with their individual roles, accountabilities and statutory responsibilities.
- To understand how national regulators are responding to the changes in modes of planning and commissioning and actual service configurations, in the light of the changed priorities for these regulators set out in the LTP.
- To understand which mechanisms are used to commission services in ICSs or ICOs or their successors, in particular how competition is used to improve quality and/or value for money of services; and how more complex forms of contract (such as alliancing) are being used, how local organisations are reconciling new service configurations with current/evolving pricing structures, and thus how financial incentives are being used.
- To understand how locality priorities, including those of local authorities, are reconciled with the wider priorities embodied in STPs, ICOs and ICSs, in particular how co-ordination is achieved between STP and ICS/ICO plans, local priorities and existing programmes of work such as any local new models of care.
Publications
Sanderson M, Allen P, Osipovic D, et al. Developing architecture of system management in the English NHS: evidence from a qualitative study of three Integrated Care Systems. BMJ Open 2023;13:e065993.
Full report
The aim of our research was to investigate the development of Integrated Care Systems (ICSs) in order to find out how effective these new forms of collaboration are in achieving their goals, and what factors influence this. The research investigated how ICSs were developing locally, the way system partners were reconciling organisational and system roles, how collaborations and providers could be held to account, the way local priorities were being reconciled with system priorities, and whether ICSs are able to allocate resources more efficiently across sectoral boundaries and bring their local health economies into financial balance.
Our research was conducted in two phases and used qualitative methods with a small quantitative component. Primarily, we used a case study research design, consisting of three in-depth case studies, each consisting of a system and its partners. The first phase of fieldwork was undertaken between December 2019 and March 2020 and focused on studying ICSs (and their predecessor STPs). Fieldwork was interrupted in March 2020 by the COVID-19 pandemic. The second phase of fieldwork took place between January 2021 and September 2021 and focused on a more detailed examination of one place within each of our case studies.
Our research suggests that the move to a more collaborative ethos has been welcomed, and system partners widely support the development of system working, and the opportunities for improved planning and provision of services which they believed system working offers. Local actors felt that collaboration in systems led to improvements to service planning and delivery in ways that did not occur previously. However, our findings also suggest that there are a number of key themes which need to be considered in relation to the capacity of systems to achieve their aims, including bringing their local health economies into financial balance. These are: the ongoing influence of competition; the importance of context; clarity of governance arrangements; limits of the consensual model of decision making; the development of accountability; and management of conflicts of interest.
Interim report
This report sets out the interim findings of our study of the development of Integrated Care Systems. We are engaged with three case studies of ICSs in different stages of maturity, examining the development of leadership and co-operative arrangements, the way system partners are reconciling individual and system roles and the way local priorities are being reconciled with system priorities.