The NHS in England is about to embark on another round of reorganisation. Under the plans – set to be implemented by April 2022 – every part of England will be covered by an ICS. ICSs currently exist informally in 42 parts of the country, each covering a population of around 1–3 million. ICSs are partnerships between NHS, local government and other agencies, with responsibility for planning services and managing resources to improve health and care in their area. A key aim of an ICS is to provide more integrated services and strengthen disease prevention. One mechanism for doing this will be through local initiatives, such as multidisciplinary teams (MDTs) that bring together staff from general practice, social care, mental health and other health-related services to provide more coordinated care.
The idea of providing more integrated health and social care is nothing new – and has been a key policy aim in the UK and other countries for decades. In England, the most recent large-scale integrated care programme was the new care model vanguards, introduced in 2015. These vanguards developed a mix of approaches to joining up local services, including MDTs, to improve care for people with complex needs. Vanguard areas received additional funding and central support to develop these new services. The vanguard programme ran formally until 2018, but many of the models of care developed through this programme have since continued. Similarly to many earlier integrated care initiatives in England, a key aim of the programme was to reduce avoidable hospital activity.
Understanding evidence from these earlier policy initiatives can provide important lessons to inform the development of ICSs in this latest round of NHS reform – including expectations for what they can deliver, and by when. The IAU examined four of its own long-term evaluations of the impact of the recent vanguard programmes on emergency hospital use, looking at impacts over 4.5–6 years. This long read summarises the key findings from these evaluations and the implications for newly established ICSs.