A focus on short-term NHS operational pressures and a lack of long-term financial security will stand in the way of health systems helping the government to achieve its ambition of delivering more care in the community and in primary care.
This is according to the NHS Confederation’s major new survey of Integrated Care System (ICS) leaders, which has found that while nine in ten are committed to shifting more care out of hospitals, there are widespread concerns that a lack of long-term investment and planning is holding them back.
ICS leaders support the Government’s ambitions and want to increase investment in primary care and community services to prevent worsening ill health, as well as designing new models of care to keep patients out of hospitals. Without this, they will continue to be trapped in a short-term cycle of having to make budget cuts, rather than focusing on delivering care transformation. However, they warn that new directives on national priorities tend to focus on short-term performance and financial issues, which, while important, risk crowding out a concurrent focus on the longer-term changes they know are necessary to put the NHS on a more sustainable footing.
Survey findings
This was one of the most comprehensive surveys of the opinions of ICS leaders, receiving responses from over 85% of England’s ICSs. It found:
• Nine in ten ICS leaders say their local system has made a strategic commitment to shift the allocation of resources to allow more people to be treated in their local community and access more care closer to home, but only 54% said they had made progress towards this
• Nearly nine in ten (87%) say they will not be able to meet their ambitions within their current budgets
• Around 86% of leaders say they are worried the financial position of their local authorities will affect the delivery of their ICS’s ambitions.
• Only four in ten leaders believe that accountabilities are well defined between ICSs and NHS England – this is despite ICSs having been established three years ago. This lack of clarity continues to cause confusion, especially when it comes to oversight of the performance of NHS providers.
One Integrated Care Board Chief Financial Officer told the NHS Confederation that a relentless focus on NHS finances “today” can inhibit “building for tomorrow.” Several ICS leaders highlighted examples of where unclear accountabilities can lead to confusion and duplication.
These findings come after the Lord Darzi report highlighted that while a top-down reorganisation isn’t wanted or needed, the NHS has work to do to get a clearer accountability structure.
Kathy McLean, Chair of the NHS Confederation’s ICS Network, says: “ICS leaders are very positive about the impact they are having and the many examples in the report show the progress that is being made. They are committed to delivering their four purposes including shifting care closer to home and reducing inequalities in health outcomes.
“But as this report makes clear there are barriers that the Government and NHS England need to help us overcome if this vision is to become a reality. Not only do they need more support to bring about these changes, but they need the freedom to focus on the long-term goals necessary to put the health and care system on a sustainable footing.
“ICS leaders accept that short-term performance and financial issues need to be addressed on behalf of their populations. But the focus on NHS finances risks crowding out the longer-term transformation ICSs were established to deliver.”
The NHS Confederation report – The state of integrated care systems 2023/24: Tackling today while building for tomorrow – recommends the Department of Health and Social Care and NHS England set out multi-year funding settlements to move away from short-term financial planning. This will give the NHS the security it needs to drive forward the Government’s ambition of moving care closer to home.
