Despite COVID, we should remain cautiously optimistic about ICS rollout

William Pett


Senior Policy Advisor

NHS Confederation

There has been understandable speculation about the extent to which COVID-19 will impact on the intended reconfiguration of NHS services that was set out in the NHS Long Term Plan.

Questions have been raised, for instance, on what coronavirus will mean for the commitment of universal coverage of integrated care systems (ICSs) across England by April 2021. At national level changes have already been forthcoming with NHS England & Improvement (NHSEI) pausing the ‘system by default’ initiative to grant more control and decision-making powers to local systems.

The NHS Confederation wanted to explore what next steps system leaders themselves would like to see as we begin to look beyond the emergency response to COVID-19 – specifically among the sustainability and transformation partnerships (STPs) yet to reach ICS maturity. As we set out in our report ‘STPs: One year to go?’ last week, the findings give cause for optimism. Far from stalling progress on integrated care, COVID-19 has in many respects accelerated it. Clinicians for many years resistant to digitisation of services have realised the value digital platforms can offer to patients, whilst communication has in many areas improved significantly between secondary and community services.

Contrary to a postponement, therefore, the consensus among STPs is that the April 2021 deadline should be upheld.  In our report, we argue it is essential to maintain the momentum behind transformation, and put systems at the centre of their own local recovery process. As Sir Chris Ham has argued, COVID-19 is best understood as a pattern of ‘local outbreaks rather than a national pandemic’ with differing levels of impact in each community.

What the devolution of powers to ICSs looks like in practice is, of course, contentious. The government is reluctant to oversee another ‘top-down reorganisation’ of the NHS. Yet without legislative powers, how can systems with resistant foundation trusts ensure that they play ball in integrating services? And how will ICSs, to whom public funds will increasingly be directed, be held to account? These are thorny, critical issues that the NHS Confederation hopes to help the government and NHSEI find solutions to over the coming months.