NHS Confederation responds to National Audit Office review of integrated care systems

The NHS Confederation welcomes the National Audit Office (NAO) review into the initial set up of integrated care systems and the opportunity our members have had to contribute to the findings. The NHS Confederation is the only membership body for integrated care systems (ICSs), with all 42 ICSs in voluntary membership.

Commenting in response to the review, Sarah Walter, director of the NHS Confederation’s ICS network, said:

“The introduction of integrated care systems presents a unique opportunity to plan and deliver patient care differently across the NHS and social care. But as the NAO rightly recognises, change will not happen overnight and local systems need the time, space and support to deliver on their ambitions 

“That means government action to address the fundamental challenges of constrained funding, huge staff shortages, lack of capital investment and commitment to tackle health inequalities. It also means committing to no further structural reorganisation for the next decade so that the current reforms can be embedded.    

“Many of the barriers highlighted by the NAO still ring true to what our members are experiencing. Recently, ICS leaders have been growing increasingly concerned by the government’s lack of attention and coherence across its departments on actions to tackle the wider determinants of ill-health. The pausing of its planned obesity and mental health strategies, in addition to the apparent disappearance of the white paper on health disparities, and the rowing back on net zero targets, adds fuel to the fire as does the government’s fixation on narrow, short-term priorities. This matters because alongside identifying efficiencies in care, ICSs are eager to deliver meaningful prevention plans that can keep people well and away from needing as many clinical interventions.

“They need time and space for their medium and longer-term planning, which we are glad NHS England recognises in its new operating framework for the NHS. However, the litmus test will be whether we are able to truly empower local systems to lead on behalf of their local communities or whether we continue to see too much command and control from the centre of government and its national bodies. ICS leaders are clear that they cannot be subjected to further national targets at the expense of tackling specific local issues, especially when central funding is not given to deliver them.

“While ICSs cannot be a silver bullet on their own, they will play a crucial role in helping to address the considerable challenges we face. That’s why the majority of the NHS and our partners were so supportive of their introduction in the passage of the Health and Care Act 2022.”