NHS must be given long-term financial security to move more care closer to home

A major new survey from the NHS Confederation of integrated care system (ICS) leaders has found that while nine in ten are committed to shifting more care out of hospitals, there are widespread concerns that a lack of long-term investment and planning is holding them back.

They support the government’s ambitions and want to increase investment in primary care and community services to prevent worsening ill health, as well as designing new models of care to keep patients out of hospitals. Without this, they will continue to be trapped in a short-term cycle of having to make budget cuts, rather than focusing on delivering care transformation.

ICS leaders warn that new directives on national priorities tend to focus on short-term performance and financial issues, which, while important, risk crowding out a concurrent focus on the longer-term changes they know are necessary to put the NHS on a more sustainable footing.

One of the most comprehensive surveys of ICS leader opinion, made up of chairs and chief executives across ICBs and ICPs and with responses from over 85 per cent of England’s ICSs, found:

• Nine in ten ICS leaders say their local system has made a strategic commitment to shift the allocation of resources to allow more people to be treated in their local community and access more care closer to home. But only 54 per cent said they had made progress towards this.
• Nearly nine in ten (87 per cent) say they will not be able to meet their ambitions within their current budgets.
• Around 86 per cent of leaders said they were worried the financial position of their local authorities will affect the delivery of their ICS’s ambitions.
• Only four in ten leaders believe that accountabilities are well defined between ICSs and NHS England – this is despite ICSs having been established three years ago. This lack of clarity continues to cause confusion, especially when it comes to oversight of the performance of NHS providers.

One integrated care board chief financial officer told the NHS Confederation that a relentless focus on NHS finances “today” can inhibit “building for tomorrow” and several ICS leaders highlighted examples of where unclear accountabilities can lead to confusion and duplication.  

These findings come after the Lord Darzi report highlighted that while a top-down reorganisation isn’t wanted or needed, the NHS has work to do to get a clearer accountability structure.

Kathy McLean, chair of the NHS Confederation’s ICS Network, said:

“ICS leaders are very positive about the impact they are having and the many examples in the report show the progress that is being made. They are committed to delivering their four purposes including shifting care closer to home and reducing inequalities in health outcomes.

“But as this report makes clear there are barriers that the government and NHS England need to help us overcome if this vision is to become a reality.

“Not only do they need more support to bring about these changes, but they need the freedom to focus on the long-term goals necessary to put the health and care system on a sustainable footing.

“ICS leaders accept that short-term performance and financial issues need to be addressed on behalf of their populations. But the focus on NHS finances risks crowding out the longer-term transformation ICSs were established to deliver.”

Sarah Walter, director of the NHS Confederation’s ICS Network, said:

“ICS leaders welcome the government’s commitment to transferring care closer to home.

“But they need the tools and support to make this happen and these aren’t yet in place. ICS leaders are still having to prioritise short-term funding and performance over the long-term changes they know are necessary to put the NHS on a sustainable footing.

“ICS leaders are positive about the impact they can make and want to make this shift, but it is difficult to move resources from acute trusts in particular when those trusts are struggling to meet demand with their current funding.

“ICSs and national government can be key delivery partners in making these changes, which are the only way to put the health and care system on a sustainable footing and improve the health and prosperity of the nation.”

The NHS Confederation report – The state of integrated care systems 2023/23: Tackling today while building for tomorrow – recommends the Department of Health and Social Care and NHS England set out multi-year funding settlements to move away from short-term financial planning. This will give the NHS the security it needs to drive forward the government’s ambition of moving care closer to home.

In order to balance budgets this financial year, ICSs are having to cut back, delay or defer the programmes that will lead to future financial sustainability as well as improved outcomes.

NHS leaders have already raised concerns that without any additional funding they will face yet more impossible choices between balancing their books and cutting services and staffing posts.

The NHS Confederation has previously called on the Chancellor to use her first budget on 30 October to plug the health service’s £2.2 billion deficit.

The report showed that ICS leaders were positive about the progress their local systems are making and will play a key role in delivering the government’s reform agenda.

Other recommendations include evolving and embedding the new operating framework, ensuring oversight incentivises a balance between today and tomorrow, and giving ICBs levers to devolve decisions to place and neighbourhoods.

About us

We are the membership organisation that brings together, supports and speaks for the whole healthcare system in England, Wales and Northern Ireland. The members we represent employ 1.5 million staff, care for more than 1 million patients a day and control £150 billion of public expenditure. We promote collaboration and partnership working as the key to improving population health, delivering high-quality care and reducing health inequalities.