Working to make government more effective

Insight paper

Enabling Integrated Care Systems to work better

Most of the money that flows to the NHS now goes through ICSs.

NHS admin work
Integrated Care Systems were created under the 2022 Health and Care Act.

One of NHS England's roles is to take some of the management of the NHS out of the Department of Health and Social Care. Since 2022 it has done this with the help of Integrated Care Systems – but talk to senior officials in these bodies and the complaints about various forms of micromanagement are almost as loud as ever.

The tension between centralism and localism has been one of the recurring themes of NHS history. Since the mid-1980s there has, in one form or another, been an NHS executive aimed at separating, at least to a degree, the management of the service from the setting of strategy and priorities by ministers. 

NHS England, as a statutory board, is the latest and nominally most independent of these arrangements. One of its prime roles is to enable Integrated Care Systems, which consist of Integrated Care Partnerships and Integrated Care Boards, to fulfil their multiple duties, which include getting money into the health system, and bringing together the NHS, local government, social care, voluntary and other sectors. But frustrations remain.

This short paper, based on interviews with those involved in ICSs, looks at how the new arrangements can be made to work better.

Related content