Integrated Care Systems

The Health and Care Act, passed in May 2022, has fragmented the NHS in England into 42 semi-independent areas known as Integrated Care Systems (ICSs).

ICSs’ apparent aim is to integrate health and care organisations: each ICS is charged with bringing together NHS bodies (such as hospital trusts), local councils and others (potentially private companies) to take joint responsibility for delivering services within a fixed budget for those people registered within its area.

KONP strongly supports the integration of services where this improves patient care: many NHS and care staff already work hard to achieve this. But ICSs are first and foremost about making the organisations within an ICS work together to reduce patients’ use of NHS services and so save money. There are also concerns that ICSs further the privatisation of the NHS: they provide new opportunities for the private sector to both influence service provision and profit from public funding, as well as gaining increased access to patients’ health data.


What is an ICS?

ICSs have two key roles:

  • to bring about ‘system transformation’ by, for example,
    • changing local health and care services;
    • developing new strategies for the infrastructure needed
    • rethinking how to exploit the remaining publicly-owned NHS buildings and land; and
    • rethinking how to redeploy the healthcare workforce.
  • to control the performance of all organisations within the ICS, especially their financial performance.


An ICS will provide services for populations of varying sizes but roughly for between one and three million people.  They have three main tiers:

  • an overall ‘system’, managed by an Integrated Care Board (ICB), a statutory body that sets an ICS’s strategic direction and ultimately controls spending, although some funds and commissioning of services are delegated to ‘places’.
  • the level of ‘place’, typically covering a population of around 250,000 to 500,000, and usually contained within the boundaries of a single local authority borough. Places are managed by an Integrated Care Partnership (ICP), also a statutory body but one where membership may include representatives from the private sector; and
  • the level of neighbourhood, typically covering a population of between 30,000 to 50,000, where, e.g., groups of GPs and community-based services work together, and managed

Taking action
See our webpage on taking action about ICSs here

Background information

NHSE papers

NHSE’s report on Consultation on the White Paper: Legislating for ICSs