Short-term issues hampering ICS progress, says PAC report


Major new reforms of the NHS will not work until government addresses multiple chronic issues in the service, the Public Accounts Committee (PAC) has said in a report released today.

PAC’s report cites a “decrepit NHS estate, record treatment backlogs [and] workforce and financial issues” as posing risks to the health of the nation, patient safety and the success of integrated care systems (ICSs).

The report has been produced following the Committee’s Introducing Integrated Care Systems inquiry, which was commissioned in 2022. It sought to establish whether ICSs have been set up in a way that will allow them to achieve their objectives of improving population health and healthcare outcomes; tackling inequalities in outcomes, experience, and access to healthcare; enhancing productivity and value for money; and helping the NHS support broader social and economic development.

“While the ambition is right, the tool kit simply isn’t there to deliver on it.”

It states that while ICSs hold the potential to improve population health by joining up services and focusing on preventing the causes of ill-health, the new systems will not be able to achieve their objectives if longstanding challenges facing the NHS and social care remain unresolved. Lead PAC member, Anne Marie Morris MP, said of this tension that “while the ambition [of ICSs] is right, the tool kit simply isn’t there to deliver on it.”

While short-term challenges such as the elective care backlog and A&E waiting times are taking up much of the day-to-day focus of the NHS, PAC’s report argues that ICSs will struggle to progress on their longer-term objectives around population health, reducing health inequalities and preventing avoidable ill-health in the future.

At a national level, it says, “not enough is being done to focus on preventing ill health [and] there do not appear to be effective arrangements for joint working between government departments to tackle the causes of ill-health.” The report also singles out “NHS England’s failure to ensure adequate NHS funded dental care”, as risking an increase in acute dental health problems.

Furthermore, the report expresses concern that “accountability arrangements [for ICSs] appear under-developed [and that] there is a concerning lack of oversight of ICSs.” On concerns over the extent to which ICSs have created an ‘integrated’ system, it states that “it is not clear who will intervene if joint working between the NHS, local government and other partners break down.”

The report does praise the government’s consultative approach during the development of ICSs and attributes the largely positive reception ICSs have received to the fact that different models were trialled before legislation was implemented.

“There is no clear responsibility for ensuring that social care is properly integrated with health care.”

Public Accounts Committee Chair, Dame Meg Hillier MP, said: “Far from improving the health of the nation, staff shortages and the dire condition of the NHS estate pose a constant risk to patient safety. But government seems paralysed, repeatedly rethinking and delaying crucial interventions and instead coming up with plans that do nothing to address the fundamental problems of funding and accountability.

“The ICS reforms have potential but there is no clear responsibility for ensuring that social care is properly integrated with health care or that patients will see the difference on the ground. Changes will not succeed if they are imposed on the NHS in its current state. Government needs to get a grip on the wider, full-blown health and social care crisis it allowed to develop from long before the pandemic.”

Sarah Walter, Director of the ICS Network at the NHS Confederation, commented: “The introduction of ICSs was overwhelmingly supported by the sector. With limited resources and ever-increasing demand for health and care, it makes sense for greater collaboration between the NHS, local government and other partners to improve population health, reduce inequalities, improve efficiency and provide a more joined-up experience for local communities.

“ICSs were never intended as a silver bullet that will solve all the entrenched challenges facing the NHS and social care. Judging their success on this, and after only seven months since entering the statute books, would be unfair as we know these macro issues require additional investment and support at a national level.

The government has two months to respond to the report’s recommendations.

The Public Accounts Committee’s full report can be viewed here.