• Four new “integrated care systems” named
  • Arrangements for existing 10 ICS still being finalised

Four new “integrated care systems” have been named by NHS England and NHS Improvement, as they continue to “finalise the details” of a financial regime for the existing ten ICS.

The additional four are:

  • Gloucestershire;
  • Suffolk and North East Essex;
  • West, North and East Cumbria; and
  • West Yorkshire and Harrogate.

All four are existing sustainability and transformation partnerships. HSJ analysis of health system performance last month identified them as better performers than most others on important financial and access measures. 

A paper to a joint board meeting of NHSE and NHSi today says: “These systems demonstrate strong leadership teams, capable of acting collectively, and with an appetite for taking responsibility for their own performance.

“They have also set out ambitious plans for strengthening primary care, integrating services and collaborating between providers. Although they experience the operational and financial pressures that other systems do, our assessment is that they are more likely to improve performance against NHS Constitution standards and clinical and financial sustainability by working together as a system.”

NHS England officials had initially hoped to announce additional ICS at the beginning of 2018, but it has been subject to delays.

The paper also gives an update on the ten “shadow” ICS identified by NHSE last summer, then referred to as “accountable care systems”.

They have been in discussions in recent months about which can become full ICS, and about recognising progress to different levels. As HSJ revealed last month, most or all of the ICS rejected proposals in refreshed 2018-19 planning guidance to make large amounts of organisations’ sustainability funding contingent on hitting a “system control total”. This could potentially have disqualified them from becoming full ICS, but NHS England is understood to have been negotiating a compromise with the systems and NHS Improvement.

Today’s board paper suggests deals are not finalised. It says the ICS need to “strengthen their collective ability to manage within their share of NHS resources”.

It continues: “To support this objective, we have developed a financial regime for integrated care systems in 2018-19 that places greater emphasis on system financial performance and requires organisations to link a proportion of their commissioner and provider sustainability funding to achieving their combined system control total.

“We will finalise the details of this regime with the ten systems in the next few weeks, in line with the refreshing of 2018-19 operational plans.” 

The paper also says of the ten: “These systems have each developed a system operating plan that expresses their collective priorities, underpins their system control total and reconciles activity and expenditure between commissioners and providers.

“The planning refresh for these integrated systems was completed much more quickly and easily than in past rounds, further demonstrating how collaboration between organisations can significantly reduce poor value transactional behaviours and costs.”