ICSs are the most recent national initiative to deliver joined-up care, preceded on a smaller scale by the vanguard programme announced in the Five year forward view and then by accountable care systems (ACSs) and STPs, a development from the original sustainability and transformation plans. Crucially, systems have no statutory basis in their own right and rest on the willingness of their component organisations – trusts, clinical commissioning groups (CCGs), local authorities, primary care and the community and voluntary sector – to work together to plan how to improve health and care.
The 2018/19 planning guidance (NHS England, 2019) suggested that all STPs would become ICSs over time and the long term plan subsequently set out a deadline of April 2021. Although further guidance has yet to be issued, STPs and ICSs are importantly expected to submit five-year operational plans for approval (NHS England, 2018) by Autumn 2019.
Forty-four areas of England were originally identified as the geographical footprints for STPs. Following the merger of three STPs in the north east, we now understand there are 42 STPs, 14 of which have already been confirmed as ICSs.
Progress in developing ICSs varies from place to place. Trusts are under pressure from regulators to focus on improving their own performance as well as responding to the challenges of transformation in an extremely tight financial climate. Timescales for developing meaningful system level plans are tight and a key concern. In addition, issues with public and local political engagement and in engaging key partners such as local authorities in system working, persist in many areas.