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Legal changes to Integrated Care Systems bring both scepticism and opportunity to local leaders

Chris Maxsted

Friday 1st July marked another step in the journey towards more integrated health and care services across England, with integrated care systems (ICSs) becoming formal legal entities. Having attended both NHS ConfedExpo and the LGA Annual Conference in the last few weeks, I have witnessed optimism about what these organisations can achieve. But there is also a reasonable degree of scepticism, with many of the more experienced heads pointing to other ‘here today, gone tomorrow’ reforms in the last 75 years that have failed to live up to the initial hype.

As a recent Treasury civil servant, I know that central government is not naïve about how difficult good integration is, however, at the same time I understand the temptation to think that the opportunities of integration can be best achieved by re-shaping government, pooling budgets, and amending regulations and incentives for systems.

My colleague, James Swaffield’s recent blog focused on how place-based approaches are not new and both conferences were full of examples where services have already been designed to work across system boundaries, such as the Jean Bishop Integrated Care Centre in Hull. In each case, those responsible for the projects made clear that although better integration at leadership and system level had been helpful, delivery was largely down to a clear change vision. Implementing this vision involves making the most of existing strengths in an area, coupled with a tremendous amount of hard work. It’s also clear that what works for one area may not for another – history is much more likely to be the essential driver of success rather than geography.

Since joining IMPOWER, I have had the opportunity to work with people across the country delivering services at the margins where different organisations meet. It’s clear that frontline staff such as social workers, doctors and nurses recognise the opportunities that integration can bring but long-established behaviours, processes and cultures make it difficult to deliver lasting change. In each case the blockers to effective integration are unique and there are no silver bullets.

Similarly at a system level, very few doubt the value of better integration, and welcome the increased attention that care out of hospital is receiving nationally. But for local leaders, the challenges today are already immense. Workforce shortages, funding squeezes and Covid recovery are taking up a large proportion of senior bandwidth. Add to that integration, adult social care reform and increased regulatory scrutiny (to name but a few) and it’s easy to see why scepticism of the latest top-down reorganisation is so prevalent. As a result, It’s also easy to see why it will be so hard to capitalise on the opportunities that changes in system governance bring. This would be a great shame.

IMPOWER has over 20 years’ experience of delivering lasting change across systems through its unique EDGEWORK® approach. This encourages leaders to embrace complexity, looking at the whole system that has an impact on their local communities and focusing on what they can control or influence to deliver lasting change. The formal introduction of ICSs and other reforms means that the boundaries of pre-existing spheres of control and influence have shifted. There are no one-size-fits-all solutions, but by stepping back to review what has changed, leaders will be able to identify new opportunities that could, through maximising existing assets and hard work, deliver lasting, meaningful change for local citizens.

If you want to find out more about how we can work with you, please get in touch.

Written by

Chris Maxsted

Delivery Director, IMPOWER



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