Delivering together: developing effective accountability in integrated care systems

Integrated care systems (ICSs) bring together local providers, commissioners and local authorities to improve population health and wellbeing. Every area of the country is to be covered by an ICS by April 2021, but there remains considerable uncertainty about the accountability and governance arrangements of these systems.

This paper, produced by the NHS Confederation's ICS Network and Solace, summarises the views of senior leaders from the NHS and local government on how they would like system accountability to develop.

What we heard:

1) Internal accountability within systems

• Better internal accountability can be achieved through greater clarity about the function of ICSs, developing a clear set of outcomes to deliver collectively and by working through locally how the roles of the constituent organisations can fit together to deliver them.
• Local relationships and ways of working should be given time to develop further and this should be key to any future consideration of statutory change.

2) Regional and national system accountability

• There needs to be a shift to a more mature oversight and regulatory relationship with systems driven by local needs and aspirations. This should take a broader-based approach beyond delivery of healthcare and be open to challenge about legitimate national aspirations for improving services.
• ICSs should be “smart, ambitious, translational systems” which are “confident enough not to need to ask for permission, but able to ask for forgiveness if necessary”.
• The NHS’s national improvement goals should be developed much more closely with local systems to ensure their ambition is closely informed by local intelligence and thinking.

3) Accountability to local communities

• Local accountability should be driven “from the ground up” within an ICS, incorporating a clear role for elected members of local authorities and accompanied by more acceptance of ‘managed difference’ of services if they are to be tailored to meet local need.
• Primary care networks and integrated care partnerships should be used to drive forward an agenda of improving the lives of local people. However, they should not be “smothered” by attaching too many objectives to them at an early stage.

Much more thinking is needed locally and nationally on this subject. We hope this report will support the local development of ICS accountabilities alongside further national thinking about the future direction of travel needed to allow ICSs to operate to their full potential.

Download the report and find out more about the ICS Network.