People, partnerships and place: How can ICSs turn the rhetoric into reality?

Integrated care systems are now legally responsible for leading the charge on using a localised approach to bring multiple aspects of the health care system closer together, and for working better with social care and other public services. But this is far from a new aspiration - why should it be any different this time? Nuffield Trust hosted a series of roundtables to discuss concerns with stakeholders and experts and understand how to ensure the aims are achieved. This new report consolidates these findings and offers ways forward as the new era gets underway.

A new era for health and social care formally arrived in England last year when 42 integrated care systems (ICSs) begame legally enshrined as the bodies responsible for integrating the NHS and its composite parts with local authorities and other services. The idea behind this approach to integrating care is that the design of services and their delivery will be driven locally at 'place' level, largely in line with health and wellbeing board geographies.

But given the longstanding history of integration as the focus of health and care policy, it is perhaps no surprise that many are sceptical about how and why these latest efforts will be different. Structures and organisational charts are evolving, but it is unclear yet what and whether real change will follow.

With this in mind, Nuffield Trust hosted a series of roundtable workshops as the new legislation was being formed and when ICSs became statutory entities in July 2022. We invited over 50 stakeholders representing varied perspectives and parts of the system and asked them to think about what integration at the local, place level might look like and what might need to change to realise that vision.


The workshops found five main risks to integration that appear to remain unresolved by current reforms. These are:

  • Embedded culture and behaviours and inter-organisational power dynamics
  • Organisational complexity, duplication, and overlapping focus
  • Resource constraints
  • Difficulties in defining, measuring and evaluating integration
  • Integration fatigue.

In response, this report offers some suggested approaches to mitigating those risks, which should be the focus of system leaders as partnerships take hold. These include:

  • Ways of building integration into the day job
  • Bringing clarity to the complexity of governance structures
  • Better use of performance management, metrics and data
  • Fostering culture change through greater mutual understanding
  • Rebalancing capacity, including management capacity.


Suggested citation

Buckingham H, Reed SJ, Kumpunen S and Lewis R (2023) People, partnerships and place: How can ICSs turn the rhetoric into reality?. Briefing, Nuffield Trust