Transform: Integrated care systems

Integrated care systems

Integrated care systems (ICS) were formalised with the introduction of Integrated Care Boards (Establishment) Order 2022, replacing clinical commissioning groups. 

One of the aims of ICSs is to realise the opportunities for collaboration across a range of providers to deliver care. Health Secretary Wes Streeting said:

“Care workers will be better supported to take on further duties to deliver health interventions, such as blood pressure checks, meaning people can receive more routine checks and care at home without needing to travel to healthcare settings.”

Collaboration can be a key factor in increasing the talent pool, with opportunities to create roles that straddle both health and care sectors. The quality of care that staff can deliver, in both social services and in healthcare, also has a significant impact on their job satisfaction.

Participants discussed a collaborative project between the NHS and Skills for Care, focusing on integrated workforce thinking. The emphasis was on viewing the workforce holistically and fostering collaboration across the health and care sector.

The discussion highlighted the importance of inclusivity, aiming to attract a diverse range of professionals to both social and healthcare sectors. Communication challenges were noted, with an emphasis on the need for clear understanding of terms used across the sector.

Participants critiqued the narrow focus of certain health discussions, but recognised the potential for innovation in smaller, collaborative groups. The session concluded with a consensus on the need for a mindset shift towards integrated care, aiming for practical implementation in the future.

Challenges

The discussion led to these challenges to integration being identified:

• Financial constraints: A report published in autumn 2024 indicated that financial constraints have significantly impacted the progress of ICSs. Despite high confidence in the potential of ICSs, the lack of adequate funding remains a major hurdle.

• Workforce integration and collaboration: Although there have been opportunities for collaboration highlighted during the pandemic, there is a need for more concrete actions beyond theoretical discussions. One care leader pointed out the lack of sufficient action, emphasising the need to move beyond theory.

• Parity and respect issues: Another participant highlighted the disparity in terms of work and respect between the NHS and social care sectors. There is a perceived lack of respect and recognition from the NHS towards social care colleagues, which hampers effective integration.

• Training and supervision: There is a notable lack of equitable training and supervision for care workers. Pressure on carers to do more and unequal pay among those with similar duties demotivates care workers.

• Classism and career development: Social care faces issues of classism, where workers without degrees may face prejudice. This affects career development opportunities and the recognition of clinical skills among care workers without formal or higher education.

Recommendations

• Increase funding and resources: It is crucial to ensure that funding and resources are adequately allocated to support the integration of health and social care. This includes financial support, guidance, and recognition.

• Enhance training and supervision: Implement comprehensive training programmes and provide consistent clinical supervision to equip care workers with necessary skills and knowledge. This will also help in mitigating risks associated with care provision.

• Foster respect and equality: Promote a culture of mutual respect and understanding between the NHS and social care sectors. This can be achieved through joint training sessions and collaborative projects that highlight the value of each sector.

• Career development pathways: Develop clear career pathways within social care that offer progression beyond traditional roles. This includes recognising and rewarding specialist care workers similarly to specialist nurses.

• Address classism: Tackle classism within the sector by valuing skills and competencies over formal educational qualifications. This can be supported by introducing roles that recognise and utilise the clinical skills of care workers without degrees. The integration of health and social care through ICSs presents a promising future for patient care.

However, addressing the identified challenges and implementing the recommended strategies is essential for realising the full potential of integrated care systems. 

By fostering collaboration, respect and equitable treatment across sectors, integrated care systems could significantly enhance both patient care and job satisfaction among care workers.