Long-term plan: key role for ICSs

The long-term plan acknowledged that local systems are in different stages of ICS development and promised tailored support to each area. However, it said that local financial planning and decisions on services will be at ICS level and trusts and clinical commissioning groups must work together. CCGs will become more streamlined organisations and, typically, there will be one CCG for each ICS.

There will be greater freedom for ICSs and sustainability and transformation partnerships (STPs) to agree changes to control totals within their systems, where this will improve operational and financial performance overall. However, such changes must be financially neutral.

Funding flows and contract reforms will support the development of ICSs – reforms will include the new integrated care provider contract, which will be available in 2019 and allows, for the first time, for the contractual integration of primary medical services with others.

Further financial reforms to support ICSs will be introduced after 2019/20. Through earned autonomy based on a track record of strong financial and performance delivery, local health systems will be given greater control over resources. Eligibility for greater autonomy will be assessed in part through the new ICS accountability and performance framework.

ICSs will be built on strong and effective providers and commissioners with clear accountabilities. Trust boards are responsible for the quality of the care they provide and for the financial resources and staff they manage, the long-term plan said. However, many initiatives would require cross-body action – trusts and commissioners must work collaboratively to agree the services each organisation will provide and the costs that will be incurred. This will ensure the system remains within its budget.

Neither trusts nor CCGs should pursue courses of action that would potentially improve their financial position while adversely affecting the system as a whole. This will be managed by regional oversight, which will review organisational and system objectives alongside the performance of individual bodies.

Though most of the collaborative working could be delivered within current laws, the plan proposed some legislative changes – repealing measures in the Health and Social Care Act 2012 in particular – that could speed up integration. These include:

• Giving CCGs and providers a statutory duty to promote the triple aim of better health, better care and sustainability

• Removing barriers to place-based commissioning and public health collaboration

• Supporting the effective running of ICSs by allowing trusts and CCGs to make decisions jointly without needing to create additional bureaucracy

• Allowing greater flexibility when creating integrated care trusts to reduce administration costs and aid clinical sustainability

• Eliminating the counterproductive effects of competition rules on integration, including the Competition and Markets Authority duty to intervene in proposed NHS provider mergers, and its powers on NHS pricing and provider licence condition decisions

• Cutting delays and costs associated with commissioners automatically having to go through procurement processes

• Increasing flexibility in NHS prices to support the move away from activity-based tariffs, facilitate better integration of care and make it easier to commission some public health services as part of a bundle of care

• Making it easier for NHS England and NHS Improvement to work together.

King’s Fund chief executive Richard Murray (pictured) backed the development of ICSs. ‘We strongly support the ambition to establish integrated care systems in every part of the country by 2021,’ he said. ‘The plan sends a welcome signal that NHS organisations need to work with local authorities and other partners to deliver improvements in the health of local populations.’ 

The long-term plan said the spending review – due later this year – will set out details of the NHS capital budget and funding for education and training, as well as social care funding in the local government settlement. Trusts and CCGs will agree one-year organisational operating plans and contribute to a single year local health system-level plan.

To support local planning, local health systems will receive five-year indicative financial allocations (2019/20 to 2023/24) and, in 2019, will produce local plans for implementing the commitments outlined in the long-term plan. Nationally, a single set of interventions, proved to benefit patients and staff, will be set out and will be required of all organisations. These will include processes for standardising and aggregating procurement demand and effective e-rostering and e-job planning and processes.

Don't miss our summary of the NHS long term plan.