Responding to the proposals from NHS England and NHS Improvement on the developing role of integrated care systems (ICSs), the chief executive of NHS Providers, Chris Hopson, said:

"The proposals set out in this policy document represent a step change in the evolution of system working.

"We welcome the proposed shift to strategic commissioning and away from transactional contracting, as well as the clear emphasis on the pivotal role of trusts, and other providers, as leaders and co-leaders of collaborative arrangements at neighbourhood, place and system level.

"Trust leaders tell us that 80% of care is delivered locally where people live, so it is right to position 'place' as the key building block for integrated care in partnership with local government and others. This emphasis on providers and place and the avoidance of creating ICSs as new style, all powerful, Strategic Health Authorities, provides a sensible and pragmatic approach to the next stage of development of system working that we welcome.

"As ever, the detail of the document raises a host of complex and important questions about the detailed operation of the proposals in practice. We therefore welcome the period of engagement on these issues that the paper triggers.

What we do know is that trust leaders – and partners from across the health and care system – agree with NHS England and NHS Improvement about the need to avoid a top-down, inflexible reorganisation of the NHS, particularly in the middle of a pandemic.

"What we do know is that trust leaders – and partners from across the health and care system – agree with NHS England and NHS Improvement about the need to avoid a top-down, inflexible reorganisation of the NHS, particularly in the middle of a pandemic.

"It is important that NHS England and Improvement and the Department of Health and Social Care facilitate a robust debate with the health and care sector about the scale and implications of both these proposals and the proposed legislative reform, which we are ready and eager to contribute to."