Explained: Integrated Care Systems (ICS) and Integrated Care Providers (ICP)

The government's latest change to the NHS is already stirring up huge controversy. In the past few years plans to introduce Accountable Care Organisations have emerged, which immediately sparked connections for health campaigners between these new organisations and bodies of the same name that exist in the United States.

Accusations were made that ACOs signalled a radical move towards an insurance-based system. A court case against the government was launched involving one of the plan’s most prominent critics, Prof Stephen Hawking, which forced the government to announce a pause, to consult with the public.

NHS England tried to head off the associations with the USA by changing the name from ACO to Integrated Care Organisation or ICO.

Then in the NHS long-term plan published in January 2019, the Government reiterated its plans for integrated care and used the term Integrated Care Systems. In the long-term plan NHS England uses the term Integrated Care System (ICS) to describe a range of care models, from close partnerships between organisations through to a single organisation (an integrated care provider) being in control of integration.

So what’s behind the controversy and how could Integrated Care Systems affect the NHS and our healthcare?

Put simply ICPs bring together all the NHS services in an area under one contract.

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At present, health and social care are co-ordinated through hundreds of different contracts and are paid for out of two separate budgets; health is paid for by the NHS and social care and public health are paid for by local authorities or by means-tested charges. The Government's plan is to integrate these services.

There is little debate about the fact that there could be huge benefits from getting health and care services to work closely, merge or integrate. It has been a desirable aim amongst policy makers for many years. It is hard to achieve, but there are some examples in the NHS already.

The end-stage for the development of an ICS is a single provider holding a contract to fully integrate care for a geographical area; in the long-term plan this is called an Integrated Care Provider (ICP) and the contract is an ICP contract.

These huge ICP contracts can be awarded to an NHS organisation, a third-sector (charity/not-for-profit) or a private for-profit company. Which is where some of the controversy comes from as it would be possible for a company like Virgin Care, which already has many NHS contracts to take on this major role, but so far no ICP contracts have been signed with any organisation - public or private, although two international health firms, Centene and United Health have shown interest in helping to develop them.

Five key concerns with this version of integration

1. Why rush forward with ICPs when there is yet to be any real evidence that they will work? It is only 6 years since the last major re-organisation, which has been widely criticised.

2. Why allow private companies the opportunity to take control of such a major role? Their record in running NHS services included many examples of contracts that have failed. If this is not the intention why not just rule it out

3. If ICPs and ICSs have a capitated budget, what happens when the money runs out, who goes without care and how is this decided?

4. Surely ICSs and ICPs are destined to fail unless proper funding is restored, the same is also true of any other form of integration.

5. Does this version of integration really fit with the key principles of the NHS - e.g., How can we make sure that healthcare remains free at the point of use, when more of it will be provided in the community where means-tested social care already exists?

What's happening now?

In late 2018, integrated care organisations made the media due to two legal challenges. As a result of these legal challenges and questions from MPs, in January 2018, NHS England announced that a 12 week consultation on ICOs will take place and the process of ICO implementation was effectively paused. The consultation closed at the end of October 2018.

The NHS long-term plan published in January 2019 has as a key component the conversion of England's NHS into approximately 42 ICS. The likelihood is that these ICS areas will echo the STP areas. The plan notes that an ICS could be either based on a number of 'alliance' contracts or with a single lead provider, an integrated care provider (ICP), using a new type of contract - the ICP contract.

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