In return, integrated care system leaders gain greater freedoms to manage the operational and financial performance of services in their area. ICSs are not statutory entities, and there is no specific legislation governing how they operate. It is hoped that the new regions will develop new ways of working alongside local systems, supporting them to change and improve services as well as overseeing performance. To address this, the Care Quality Commission (CQC) has begun to test approaches to regulating systems, and NHS England and NHS Improvement has created seven joint regional teams bringing together the regulation of commissioners and providers. Integrated care may be seen as a response to the fragmented delivery of health and social services being an acknowledged … The new approach to social care in South Tyneside, Simon Bottery considers joined-up health and social care in South Tyneside, with social workers joining ‘huddles’ on wards, and using a ‘strength-based’ approach in discharge planning. Inevitably, the development of ICSs will take a back seat in the coming months as local and national health and care leaders rightly focus their efforts on responding to the Covid-19 (coronavirus) outbreak. There is no blueprint for developing an ICS; so far, their development has been a locally led process with significant differences in the size of systems and the arrangements they have put in place. Two judicial reviews were brought against NHS England in relation to the contract, but both were dismissed. This means that within the partnership that makes up an ICS, there are also smaller partnerships centred around more local areas and populations. The King’s Fund is conducting research to understand this in more detail. Concerns have also been raised in relation to the accountability and transparency of ICSs. The NHS long-term plan set out a number of expectations, such as requiring ICSs to establish a partnership board involving organisations from across the system and to appoint an independent chair, and further guidance on designing ICSs has since been published by NHS England and NHS Improvement. Key challenges in the next stages of these developments include: The scale and complexity of these changes should not be underestimated. Making Integrated Care Systems a reality – the impetus created by the pandemic 12.02.2020 As the NHS faces further pressures with an expected 30% increase in the demand for services and long waiting lists, now is the time for integrated care systems to become a reality across the NHS. co-ordination of system transformation – this means partners in the ICS working together to agree changes to local health and care services and develop supporting strategies, for example, around the development of digital infrastructure, estates and workforce. Despite being effectively mandated by NHS England and NHS Improvement, ICSs and STPs are currently voluntary partnerships as they have no basis in legislation and no formal powers or accountabilities. The national NHS bodies have adopted a permissive approach meaning that, in contrast to many previous attempts at NHS reform, the design and implementation of ICSs has been locally led within a broad national framework. ICSs do not require contractual or structural change. In line with these ambitions, NHS England and NHS Improvement has committed to changing its approach to ‘system by default’, meaning that wherever possible it would work with ICSs to identify and address performance issues rather than going directly to individual organisations. There is wide variation in the extent of their involvement across different ICSs, and while there is some evidence of progress in terms of the role of local authorities (see below) it remains unclear how voluntary and private sector organisations can be meaningfully involved despite being key delivery partners for many services.