That’s the message from new research by the King’s Fund, which sought to understand the extent to which ICSs are helping local leaders develop ‘whole-system’ solutions to some of the key challenges facing the health and social care system, focusing primarily on workforce issues owing to their impact on patient care.

What will make or break ICSs, the research report asserts, are the behaviours of national, regional and local leaders. Success relies on supporting people at all levels to think, plan and act in ‘system-focused’ ways. Thus, accountability arrangements drive behaviours that reinforce system working rather than undermine it.

ICSs bring together NHS bodies, local government, voluntary sector organisations and others to plan how they can collectively meet the needs of local people and help create the conditions for people to live healthier lives. Their introduction recognises that people using health and social care services increasingly need support from multiple parts of the system, which needs to be better connected and co-ordinated. It is now two years since ICSs were given statutory powers and budgets for the first time.

Overall, the study found that ICSs have made progress in supporting local organisations to work together in a more collaborative way on workforce issues – but this progress has been uneven and beset with challenges. The research team heard from several ICS leaders and stakeholders that a focus on resolving short-term issues, such as staff shortages, had impeded progress on some of their more transformative partnership work aiming to redesign the workforce for the future.

Adding value

Nevertheless, the research identified six ways in which ICSs are “adding value”: organising around a shared purpose; building system leadership; encouraging system-focused behaviours; scaling and spreading success; using resources more effectively; and managing complexity.

Visible changes are evident, such as introducing shared approaches to recruitment, training and staff wellbeing; introducing new roles or new pathways into the health and care workforce; and extending training opportunities to staff outside the NHS. However, the research also emphasises these changes have been underpinned by largely invisible efforts of local leaders to strengthen relationships, change mindsets, and encourage different behaviours.

Looking at what national bodies can do to help ICSs succeed, the research identified three measures, informed by conversations with 24 leaders and stakeholders from four ICS case study sites. They include being realistic about how fast ICSs can be expected to demonstrate progress on workforce and other objectives; ensuring that the frameworks and behaviours used to hold ICSs to account are proportionate and reinforce local partnership working rather than undermine it; and giving systems greater flexibility to use national funding in ways that best serve their local needs and priorities.

Enablers to success

Advocating the new Labour Government returns to the recommendations of the Hewitt Review of ICSs, published in April last year, the King’s Fund research also proposes leaders take four actions to help ICSs succeed: maintain a clear focus on long-term transformation; practise system collaboration and prepare to be challenged and to challenge behaviours not in line with the principles of system working; have a clear focus on outcomes and flexibility over the means by which these are achieved; and value the views of local people, patients and staff.

Summarising its findings, the research report acknowledges how these are early days for ICSs in ensuring they deliver improvements for people using health and care services, as well as the wider population.

“In the current context, the worst possible policy choice for national government would be to lose patience with ICSs and embark on an alternative set of structural reforms,” it warns. “Instead, it’s time to focus on how people at all levels can be supported to work differently to allow ICSs to achieve their full potential.”

Sarah Walter, director of the NHS Confederation’s Integrated Care System network, said: "Our ICS members will welcome this report from the King’s Fund, which highlights the important progress many have made in working in a more collaborative way, in particular to address workforce issues. With workforce shortages being a key strain on health and care services, ICS have a critical role, and many have risen to the challenge.”

She added: “The policies the new government has set out around a National Care Service and their commitment to the NHS Long Term Workforce Plan are welcomed by ICS leaders, but they do want to see an equivalent plan for the social care workforce. Without this, it will be very difficult for our members to achieve their ambitions in relation to building and strengthening an integrated workforce that can meet the health needs of their local communities.”

The report, ‘Realising the potential of integrated care systems’, can be found on the King’s Fund’s website.