Why is social and economic development a challenge?

Working together to improve the social, environmental and economic conditions in our communities, and the health and wellbeing of people that live in them, is a significant cross-cutting ambition. This means this is can be a crowded and contested space. There is overlap between social and economic development and the other ICS priorities around health inequalities, social determinants and population health.

There is also overlap with existing work already underway within and across ICS footprints through local and regional economic partnerships , city and town planning teams, the AHSN network, targeted action on rural and coastal development, local council's approach to support inclusive growth, the public health framework to develop inclusive and sustainable economies, the RSA’s inclusive growth commission, and more.

Every ICS, like every community, is different. There is no national blueprint or linear model to follow to progress social and economic development, and nor should there be. Recognising the different opportunities and priorities for local communities in each part of the country, NHS England has also not set specific policy on how integrated care systems should contribute to social and economic development, social value or inclusive growth. But feedback from system leaders indicates there is a lack of practical support and guidance for ICSs about how to approach this purpose in practice, and what can help partners make and progress.

Against this backdrop, turning policy rhetoric about ICSs supporting social and economic development into practice can understandably feel overwhelming and leave local leaders at a loss as to where to start.

Part of the issue in knowing where to start relates to the vast potential array of activity involved in supporting social and economic development, much of which takes place at a hyperlocal level in communities. The fact that activity can be compartmentalised, in pockets, not necessarily badged, understood or seen to be contributing to social and economic development is another issue.

Another reason why it can be difficult for local leaders to make a start on supporting social and economic development relates to the transitional phase of ICS development. Many ICSs are still in their infancy or early stages of development, working to move strategy, planning and operations from an organisational model to a whole-system approach. While ICSs move from being a collection of organisations working together in a transactional relationship, to a genuine and equal system of partnership, there will be barriers to progressing work on the social and economic agenda. For example, organisations within ICSs (from across the NHS, local government and VCSE sector) have different lines of accountability and regulation, and individual budget lines. All these factors act as a barrier to system working, especially in a constrained funding environment. 

There can also be a mismatch in timelines for planning and decision making between different partners, especially the NHS and local government. And without intentional effort to build relationships and understand each other, the differences in culture, working styles and approach, especially between the NHS and the VCSE sector, creates further challenges to overcome.

All ICSs are currently facing considerable short-term operational challenges to the delivery of health and care services in the face of the ongoing backlog post COVID-19, strike action and national funding cuts to running costs. This leaves many system leaders struggling to find the time, capacity, enthusiasm and motivation for this longer term, more strategic work, despite the consensus about its importance and potential future impact on service demand, the economy, and the health and wellbeing of people and communities.