• Two STPs plan to graduate to “integrated care systems” by the middle of 2020
  • But several health economies have confirmed they will wait until final deadline of April 2021
  • NHS Providers says timescales seem ambitious given “cultural shift” required

Many sustainability and transformation partnerships will leave it to the April 2021 deadline to become integrated care systems, HSJ analysis suggests.

Leaders of two health economies – the Cornwall and Isles of Scilly, and Humber, Coast and Vale STPs – have confirmed they intend to make the move well before the final deadline for all of England to be covered by ICSs, which is April 2021. The target was included in January’s long-term plan

But HSJ analysis suggests a significant number of the 28 remaining STPs are likely to remain at the back of the queue, amid warnings over the “ambitious” timescale for the transition in light of competing financial, performance and workforce pressures facing the NHS.

These include: Norfolk and Waveney, which was an aspirant system but has been affected by severe performance problems; Mid and South Essex; Bath, North East Somerset, Swindon and Wiltshire; Hertfordshire and West Essex; Northamptonshire; Somerset; and Kent and Medway.

The first wave of eight ICSs were announced in 2017, followed by four more in May last year and another three this June. Due to mergers there are currently 14 ICSs. The North East and North Cumbria ICS is the biggest, serving three million people. ICS status requires a health economy to demonstrate strategic leadership at a system level, a single plan covering operational and long-term transformation, and managing financial performance against a system “control total”.

Maturity index

NHS England uses a “maturity index” to assess STPs’ readiness to become an ICS, which outlines the core capabilities expected of emerging, developing, maturing and thriving systems. Only those classed as maturing are formally approved.

NHS England/Improvement guidance on designing systems in June said they would have some common features, including measures promoting collaboration across health and care sectors, but priorities and solutions would vary.

As well as the core requirements, they will be expected to reduce unwarranted clinical variation and address health inequalities, undertake workforce planning, agree how to make best use of capital, estates and digital infrastructure, and spread local good practice at scale in areas covering between one and three million people.

The guidelines appear to have given some STPs clarity over their positions as they head towards the April 2021 deadline.

Leaders of Bristol, North Somerset and South Gloucestershire STP agreed in February to progress to an ICS by April 2020 but officials say they are now “working through what will be required to become an ICS in line with the new national definitions”. Officials in Herefordshire and Worcestershire say they are making assessments against the matrix to decide if they can form an ICS by next April.

Leicester, Leicestershire and Rutland STP agreed an action plan in June to move it forward after analysis found it was “relatively immature”. Its position is further complicated over Leicestershire County Council’s continued failure to back the project.

South West London said it was planning to become an ICS before April 2021, but no decision on the timing had been taken. Cheshire and Merseyside said it was making “good progress”, while Birmingham and Solihull STP will announce its plans in November.

Overly ambitious timescale?

Miriam Deakin, director of policy and strategy at NHS Providers, said individual systems were at different stages of their journey towards becoming ICSs but there were concerns over the proposed deadline of April 2021.

“This seems ambitious to us given the cultural shift required and the wider pressures the health and care sector is still grappling with in terms of rising demand, financial pressure and widespread workforce vacancies,” she said.

“Although the current legislative framework certainly does not prevent collaboration, it was also established for different times with the aim of competition, not collaboration in mind – and this adds to the complexity trusts and their partners have to deal with as they seek to develop system working.”

The exceptions

Becoming an ICS before 2021 would constitute a major turnaround for Humber, Coast and Vale, which was one of five STPs rated “needs most improvement” by NHS England only two years ago.

It still faces significant strategic challenges around the clinical sustainability of services, while NHSE has warned that problems relating to finance and performance in all three of its sub-systems continued to have a “negative impact upon the overall reputation of the partnership”. But local officials say they hope to make rapid progress to become an ICS by the summer of 2020, after being placed on NHSE’s accelerator programme.

A spokesman added: “To support the journey to ICS status, we recognise that we need to develop our capability and capacity in a number of key areas including population health intelligence and management, quality improvement, clinical engagement and leadership development.”

Cornwall and Isles of Scilly Health and Social Care Partnership told HSJ it was intending to become an ICS in April 2020. The key post of independent chair is expected to be filled shortly following interviews at the end of this month.

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