Public Policy Projects, supported by MSD, recently bought together experts from across primary and secondary care, as well as NHS England and local government to discuss the topic of integration of health and care services and how it facilitates the principle of universal healthcare.

Constraints on NHS funding growth combined with increasing demand for healthcare as well as technological advances have resulted in a ‘black hole’ in NHS funding of around £30 billion by 2020/2021, which is only expected to grow.   In order to close this gap, new ways of providing services need to be explored.

We often refer to the NHS as one institution, but in reality, it is very fragmented, with 195 Clinical Commissioning Groups (CCGs), 135 acute non-specialist trusts, 17 acute specialist trusts, 54 mental health trusts, 35 community providers and over 7,000 GP practices. Encouraging them to work together, as well as with Local Authorities, Local Education Authorities and social and third party providers is essential if we are to have an NHS fit for the twenty first century.

The NHS released its Long-Term Plan setting out the vision of how the health service will be transformed over the next decade, to better meet patient and staff needs.   Included within this was the aspiration to boost out-of-hospital care, prevent health inequalities, offer more digital solutions, upgrade technology and improve care quality and outcomes.

From these aspirations we have seen the growth of 44 Sustainability and Transformation Plans (STPs) which evolved into Integrated Care Systems (ICS) in some areas. This journey is expected to continue, with Next Steps on the FYFV setting the goal:

“Our aim is to use the next several years to make the biggest national move to integrated care of any major western country.” – NHS Five Year Forward View

But how – and whether – Integrated Care Systems will work, and whether they are alternatives remains a topic for significant discussion.

We are grateful to the following for their contribution to this discussion:

Lord Ara Darzi Professor of Surgery

Imperial College London

Bob Alexander Associate Director, Health and Integration CIPFA
Chris Harrison Medical Director The Christie NHS Foundation Trust
Mike Morgan National Clinical Director for Respiratory Services NHS England
Matthew Swindells Deputy CEO NHS England
Ian Dodge National Director Strategy and Innovation NHS England
Harry Quilter Pinner Research Fellow IPPR
Dr Karen Kirkham National Clinical Advisor Primary Care and Clinical Lead Dorset ICS
Sally Gainsbury Senior Policy Analyst The Nuffield Trust

Recommendations of the report

  • The Government must commit to the ICS and PCN structure, in order that organisations have time to adapt and embed structural changes.
  • Steps must be taken to vertically integrate secondary care, as well as horizontally integrate at primary and community level.
  • Clear data standards need to be established, so data is comparable between localities, and can be used to improve services and patient outcomes.
  • Networks must go wider than healthcare and include education providers and other community and independent partners.
  • Standardised secondary care pathways should be developed.
  • The ICSs must embrace preventative healthcare technology and integrate it into healthcare networks.
  • Local Government must be integrated as a true partner with the ICSs.
  • The Government should use data to highlight poor performing Local Authorities or NHS organisations.
  • The role for the employer must be explored, to engage employers in the health of their workforce.
  • Non-traditional players, such as house builders, must be included with the ICS plans, to help improve overall population health.

Read the full report at