What the 10-Year Plan Means for Integrated Care Systems

Under the government’s Fit for the Future: 10-Year Health Plan, their role is set to expand even further - with the document describing ICSs as the “organising layer of health reform” designed to make local systems more responsive, data-driven and preventative.

The three core shifts; analogue to digital, sickness to prevention and hospital to community are in place to strengthen the abilities of ICSs’ in terms of joining up health and social care services, maximising funding and resources, and pushing to deliver care that’s integrated and more localised. The big question is: what will this look like in practice?

One of the plan’s most significant developments is the shift towards local decision-making. ICSs are being positioned as the driving force of this decentralisation, with the Labour government pledging to “push power out to places, providers and patients.”

Following on from the Model ICB Blueprint that was released in May this year, Integrated Care Boards (ICBs) have been instructed to move away from transactional contracts and take a more strategic approach when it comes to commissioning services and balancing funds and resources with the local needs of their respective populations. Foundation Trusts that perform well are potentially set to become Integrated Health Organisations (IHOs), responsible for larger funding pools to help provide high-quality care services across acute, mental health and community settings.

These actions denote that there is a clear desire to move away from a centralised model and make care more available and effective at a local level, with a much simpler approach to governance and with ICSs taking greater accountability for improving outcomes.

The NHS 10-Year Plan reinforces the NHS’s long-standing ambition: moving care away from hospitals and closer to people’s homes. Integrated Care Systems will play a major role in making this a reality by coordinating neighbourhood health services and bringing the likes of multi-disciplinary teams, GPs, social care workers, mental health practitioners, pharmacists, and those who work in VCSE into the mix to deliver high-quality care under one umbrella.      

Not only will these local teams be tasked with tackling the wider determinants of health, i.e. inequality, housing, employment, and loneliness, they’ll also be responsible for helping people manage long-term illness. But for this in itself to be successful, strengthening partnerships between local authorities and teams involved in public health will be imperative. Ensuring priorities and budgets are aligned will also be essential if ICSs are to make meaningful and measurable improvements to the wellbeing of local populations.

ICSs are also set to create and coordinate close to 300 neighbourhood health hubs across England by 2028, giving them a chance to make a model of care that’s truly preventative and one that doesn’t just treat people when they’re sick.

Data and digital tools will underpin how ICSs deliver care over the next decade. Fit for the Future commits to a Single Patient Record accessible across health and social care by 2028, giving clinicians and care professionals real-time visibility of a person’s medical and care history.

For ICSs, this will mean investing in shared infrastructure, interoperability standards and digital inclusion. Systems that can connect hospital, community and social care records will be able to deliver safer care, reduce duplication, and plan services based on real-world demand.

The plan also references the expanded use of AI and predictive analytics to forecast demand and identify at-risk populations earlier - a function that many ICSs are already trialling through federated data platforms. When scaled, these tools could help ICSs deploy resources more efficiently and strengthen early intervention models across primary and community care.

The plan signals a gradual shift towards outcomes-based payment models and greater financial autonomy for ICSs. Systems will be encouraged to use pooled budgets and shared incentives that reward prevention and long-term health outcomes rather than hospital activity.

Alongside this, the NHS Oversight Framework will continue to measure ICS performance based on population health, workforce sustainability and digital maturity. League tables have also been introduced to ensure ICSs remain transparent with their developments and so that any which require additional support can be identified quickly. A strong sense of leadership, robust governance and understanding of data will all be needed here for the desired outcomes to come into fruition.

Even though there is a positive lens on the accountability aspect ICSs now face, the challenging part is that many of them are currently on unequal footing. Whether this is down to workforce shortages, fragmentation in data and disjointed systems, or disparities in resources – these are all hurdles that could potentially widen an already very large gap between ICSs.

ICSs are just one of many cogs in the NHS reform machine. Nevertheless, transforming the health and social care landscape largely depends on these systems and their ability to deliver joined up, community-based care that’s digitally enabled and able to sufficiently support the NHS as it undergoes some major changes over the next decade.

ICSs will need the following in order to do this effectively:

• Invest more into their digital infrastructure and data sharing efforts.
• Aim to keep alignment with ICBs, third party providers and local authorities.
• Strong leadership capabilities and robust governance.
• Safe and sensible balance between local autonomy and national accountability.

If these conditions are met, ICSs could transform the NHS from a system defined by boundaries into one defined by collaboration. The next decade will be a true test of integration - not just as a policy ideal, but as the practical foundation of modern care.