How far will integrated health and care systems go in preventing disease?

The 2019 five-year strategic plans for integrated care systems and sustainability and transformation partnerships are due to be published any day now.

These will spell out how local integrated health and care systems aim to deliver on the ambitions of the NHS long-term plan, providing an early insight into how seriously the NHS in England takes its role in preventing disease.

But what can be gleaned from the 2016 plans, and what can ICSs and STPs do next to prevent disease, reduce inequalities, and ultimately improve the health of the population?

The role of the NHS in preventing disease

In 2019, the government’s prevention vision, the NHS long-term plan and the prevention green paper each amplified the rhetoric around how the NHS in England can do more to prevent disease.

The challenge, however, is that much of what makes us healthy lies outside of the NHS’ immediate reach ­­– our built environment, transport systems, housing, income and so on. Yet the funding that traditionally supports many of these areas has been repeatedly cut.

One potential way of enabling NHS organisations to start influencing the wider determinants of health is for them to work more closely with local government and community organisations through STPs and ICSs.

STPs were created in 2016 as 44 geographically-defined partnerships between NHS organisations, local government and community groups working together to meet the health and care needs of around 1 to 3 million people.

Then in 2019, the NHS long-term plan – NHS England and NHS Improvement’s strategic blueprint for spending over the coming five years – proposed that all STPs should become an ICS by April 2021, taking on greater responsibility for controlling spending, delivering NHS standards, preventing disease, and improving the health of local places. Fourteen have so far made the transition.

Integrated care and prevention

Both STPs and ICSs are the latest attempt in a long list of national policies aimed at providing more integrated care. But what does this mean in reality, and will it help prevent poor health?

In the NHS, integrated care is broadly used to mean one of two things: more joined up services (for example, community care teams involving both health and social care professionals) and more closely linked organisations such as NHS organisations working between one another, or NHS organisations working with non-NHS organisations.

Unfortunately, the evidence of whether these types of integration lead to better disease prevention is fairly weak. This is, in part, because studies have instead focused on other outcomes like service use and partnership formation.

Building on the 2016 STP plans - what can ICSs and STPs do next?

When the 2016 STP five-year strategic plans were written, NHS England called for a ‘radical upgrade’ in prevention. However, Health Foundation analysis of the plans found that although most included a prevention strategy, there was little detail.

Few STPs explained how they would work with local government to identify and meet local needs or address wider determinants.

Then last year, NHSE and NHSI asked ICSs and STPs to submit updated five-year plans based around delivering the aims of the NHS long-term plan. This is a real opportunity for ICSs (and those STPs yet to become an ICS) to go further on prevention and local partnership working.

And if they’re to do this, there are three areas that will need close attention:

1. How well represented are local government and volunteer, community, and social enterprise organisations? Without their meaningful engagement, it will be impossible for ICSs and STPs to understand and address local social needs or meet expectations around programmes like social prescribing.

2. What will plans say about the role of provider organisations in preventing disease? There’s much that NHS provider trusts can do using existing resources either through adopting an anchor mission, or by working to systematically identify and address patients’ preventive care and social needs. To help with this, national performance frameworks will need to be updated to align with these broader national population health ambitions.

3. How will local data and analytics be used to design and evaluate local health and care services? Linked local health and care records have the potential both to ensure that interventions are better designed to meet local needs, and to evaluate the impact of service change, thereby growing the evidence base for integration and prevention.

Beyond these areas, the case still needs to be made for a coordinated whole-government approach to prevention and long-term investment in the nation’s health, for increased local government budgets, and for reversing the cuts to public health.

Without a whole government approach, any efforts by the NHS will be swamped by the persistence of the wider factors driving much of the country’s morbidity and inequalities in the first place.