By Professor Martin Green, chief executive, Care England

In theory, ICSs are a key component of the UK Government's plans to improve the integration of health and care services. By bringing together different parts of the health and care system, ICSs aim to provide more coordinated and seamless care for patients, improve outcomes and reduce costs. There are several ways in which ICSs can improve the integration of health and 

care services. One of the main benefits of ICSs should be they can help to break down the barriers between different parts of the health and care system. Traditionally, health and care services have been provided by separate organisations, each with its own funding streams, objectives and priorities. This can lead to a fragmented and disjointed system, where people fall through the gaps and fail to receive the care they need. By bringing together different parts of the system under a single umbrella, ICSs can help to create a more seamless and coordinated approach to care. 

The hope was that ICSs would also help improve the quality of care people receive. By working together, different parts of the health and care system can share information more easily, coordinate their efforts and ensure that people receive the proper care at the right time. This can help to reduce duplication, eliminate unnecessary tests and procedures, and improve outcomes. For example, by sharing electronic health records, doctors, nurses and care professionals can have access to a person's full medical history, allowing them to make more informed decisions about their care.

Another way ICSs can improve the integration of health and care services is by promoting collaboration between different organisations. By bringing together hospitals, GP practices, social care providers and other services, ICSs can encourage these organisations to work together towards common goals. This can help to break down the silos that exist between different parts of the system, foster a culture of collaboration and cooperation and ensure that patients receive the care they need in a timely and efficient manner.

ICSs can also help to improve the efficiency of the health and care system. By coordinating their efforts and working together, different parts of the system can reduce duplication, streamline processes and eliminate waste. 

This can help reduce costs, improve productivity and ensure resources are used more effectively. For example, by sharing facilities and equipment, different organisations can better use their resources and avoid unnecessary expenses.

Sadly, all the things I have described are worthy objectives and pretend they are bringing health and care together, but I have seen little evidence that this is happening in any systematic way. ICSs were set up to enable the NHS to dominate the conversation. There is no care provider representative in the ICB in many areas and local authorities struggle to get their voices heard within this system. The idea that somehow budgets would be merged and people could access resources to secure outcomes is a pipedream. It is not happening in any systematic, measurable way in most ICSs.

Another challenge has been how these new organisations are staffed. They are often full of recycled people from the previous systems that have already failed so badly. Over the years, successive governments have focused on structural reorganisation, believing this is the mechanism to deliver change. Despite huge amounts of evidence to the contrary, they persist in this mistaken notion.

We have seen co-terminus working, joint appointments, PCTs, CCGs and Health and Well-Being Boards, all of which were going to deliver an integrated system and failed. What the Government needed to do was create a system that truly was about providing resources and things that could make the biggest impact on people's lives and this would have allowed us to shift huge amounts of money from failing NHS services and put them in other areas and also work cooperatively with citizens to deliver what makes a difference to them. 

Despite all the rhetoric and hopes for a different approach, I see little evidence that ICSs have been the game-changer that they were supposed to be. Until we wean ourselves off the obsession with organisations and structures and shift the dial to thinking about people and outcomes, we will never move from where we are to where citizens want us to be.

Send your thoughts on your burning issue to l.peart@hgluk.com