• Sarah Bickerstaffe, Director |
  • Karena Starkie-Gomez, Director |
3 min read

The delay will frustrate some systems, others will welcome it. All should use the extra time to get strong foundations in place. It’s time to focus on Form, Function, Finance and Quality.

The health and care system has achieved previously unthinkable change during the pandemic: vaccine roll-out, remote access and life-saving treatments. I understand those who want to build on that momentum and press on with the next phase of change. A sustainable trajectory for the future means integrating services around an individual and supporting healthy communities, thereby reducing need for more intense services. The creation of Integrated Care Systems provides an opportunity to reimagine how services are planned, funded and delivered locally. Delaying the statutory ‘go-live’ of Integrated Care Systems until the summer will be frustrating to some systems who want to move on at pace.

But that same extraordinary challenge has pushed the NHS and social care services to the brink. The challenges of increased demand, scarce resources and overburdened staff have intensified. So I can also see that others, still battling the effects of the latest wave, will welcome the breathing space.

All systems should take advantage of the extra time to get the strongest possible foundations in place. Our research with the public showed that whilst there are high levels of understanding and appreciation of the pressures the NHS is under, people feel let down by the administrative and structural foundations of the health system. The right set-up is crucial to give new systems the best chance of success at the monumental task they face - restoring and improving health and care for their citizens. And that means the next 5 months are absolutely vital; whatever we feel about the delay, we must make the best use of that extra time.

At KPMG we think there are four pillars that together will give ICSs strong foundations on which to build. These are Form, Function, Finance and Quality.


The starting point for great system working is trust. Not everyone can be in the room for every decision – we need to trust each other to make the right calls for citizens, people who use services, and the system. That means strong governance to enable clear decision-making at system, place and neighborhood level. Getting ICS governance and form right is a critical building block to enable a smooth transition to new structures and strong collaboration from the outset.


When systems come together with a clear shared purpose, there is enormous potential for transformation. At the heart of the integrated care agenda is the will to deliver person centred care, in the place and way that our communities want. Leaders need to dedicate time and energy to align the system behind a shared ambition. A ‘true north’, agnostic of organisation, can drive and align all actions towards a shared ambition. With the challenging backdrop of COVID-19, ICSs need to be able to agree a small number of priorities and land these quickly to create credibility and momentum.


Most systems will start life with an underlying financial deficit and will need to work together rapidly to agree a shared recovery and investment plan. A successful system-wide approach will depend on three factors: understanding the system financial position and the drivers influencing this; aligning financial governance to the needs of the system as a whole; and enabling the flow of funds to drive all elements of the system to towards the same objectives. This means doing things differently and embracing new funding models including risk sharing and incentives.


The quality of care that local people receive must be at the centre of all that Integrated Care Systems do. We know that many issues can only be tackled by people working together across the system. But shifting from an ‘organisation-first’ to a ‘system-first’ mindset requires conscious effort. Leaders need to grip quality and performance from the outset to set a culture of continuous improvement and shared accountability for outcomes. And work productively with the Care Quality Commission and NHS England and NHS Improvement towards the goal of improved quality of care for all.

The delay to Integrated Care Systems may be frustrating, but it won’t be time wasted if it is used to strengthen system fundamentals across these pillars.