Government must support the role of integrated care systems to make its child poverty strategy a success
In many parts of the country, our members are providing support to local communities to alleviate the effects of child poverty. Dr Layla McCay, director of policy at the NHS Confederation, sets out why the strategy must support and incentivise health and care systems, and particularly integrated care partnerships, to continue this critical work.
This article was first published in Public Sector Focus on 14 March 2025.
Late in January, I attended a meeting of the government’s child poverty taskforce. With other health experts, ministers and officials around the table at the Department for Work and Pensions on a rainy Tuesday afternoon, we discussed the opportunities for health services to alleviate the negative experience of living in poverty, which is the third objective of the government’s child poverty strategy.
Many of our ICS Network members – as well as members in primary care, community services, mental health and acute settings as part of system-driven initiatives – are already undertaking this important work. From employers in the NHS supporting their workforce with on-site food banks and uniform swaps, to co-locating debt and housing advice in neighbourhood health centres, our members are working innovatively in the face of the ongoing cost-of-living crisis.
At the NHS Confederation, while the majority of our government engagement still occurs through the Department of Health and Social Care (DHSC), we are increasingly engaging with departments across Whitehall. This is about recognising the specific role integrated care systems (ICSs) play in local communities, which means their inter-agency approach to local challenges must be mirrored at the national influencing level to deliver the most impact from integrated working. The fact the child poverty strategy has been set up to be explicitly cross-government from the start is something our members have wholeheartedly welcomed.
This child poverty strategy is a clear example of the Prime Minister’s mission-approach to governing. While the government talks about its mission-approach as a national endeavour (something the NHS Confederation has been pressing for some time), part of this approach needs to be about equipping local services and agencies to take their own cross-sector approach to tackling local challenges.
Two days after his government’s election in July, the Prime Minister made a speech at Number 10 about his plan to push power and resource out of Whitehall to devolved nations and combined authorities.
The breadth of membership of integrated care partnerships (ICPs) in particular – across local authorities, the NHS, the Voluntary, community and social enterprise (VCSE) sector and beyond – means they have a deep understanding of the assets available within local communities, the networks that can be utilised in pursuit of a common goal and the needs that need to be met. Many ICPs work closely with combined authorities – with Greater Manchester ICP and South Yorkshire ICP both being chaired by their respective metro mayors.
The government should consider ICPs as the local version of the government’s mission delivery board for health. Through producing integrated care strategies to improve health and care outcomes and experiences for their populations, the mechanisms for driving this activity in ICP footprints already exists.
There are a number of policy asks that the NHS Confederation has been calling on the current and previous government to implement to better enable the work of ICPs. Making these policy changes would allow the government to evidence its commitment to the value that people with ‘skin in the game’, to use the Prime Minister’s terminology from his speech on 6 July, ‘know what’s best for their communities.’
Firstly, we need to see longer-term funding cycles coordinated across DHSC, the Department of Work and Pensions, the Ministry of Housing, Communities and Local Government and the Treasury. This would enable ICSs to better plan for the delivery of integrated services that are set up to respond to the impacts of poverty. As part of this, general allocations with limited ring-fencing would support ICS leaders to design and deliver services to meet local need. Additionally, reforming payment mechanisms to drive integration and shift towards a preventative, upstream focus of investment.
Secondly, ICS leaders are keen for targets with more outcome-focused measures to incentivise them to work towards these longer-term goals, rather than being beholden to focus on activity measures.
Thirdly, the government must establish a national ICP forum. As recommended by Rt Hon Patricia Hewitt in her 2023 review of ICSs, a national forum, chaired by a minister or co-chaired by ministers, would drive cross-government working and ensure that national government is well connected to local system leaders. This would ensure that the wider policy context could support integrated, cross-agency working in system footprints.
The good news for government is that the architecture for alleviating the impact of child poverty already exists in the ICP within ICSs. The job for them is to use their child poverty strategy as the mechanism for empowering and enabling ICPs to respond to the specifics of local need and strengthen inter-agency relationships to deliver better health outcomes for those children whose lives are blighted by poverty.
Layla McCay is director of policy NHS Confederation. You can follow Layla on X @LaylaMcCay
