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The Progressive Policy Think Tank

Revealed: NHS and care integration postcode lottery leading to unequal access to treatment and support

‘Promising’ Health and Care Bill set to join up NHS and care services, but successful integration requires culture change too, says IPPR report

Following the new funding announced for the NHS and social care system, the IPPR think tank warns that improved outcomes will only be delivered if combined with changes to the way healthcare is organised and how services work together.

In a detailed review of the government’s Health and Care Bill, which is currently making its way through Parliament, IPPR suggests the proposed reforms could be a ‘turning point’ in the drive towards a more integrated healthcare system, if amendments to the bill and other non-legislative changes are also made to drive a culture of collaboration across health care providers.

Integrated Care Systems (ICSs) are 42 new partnerships being established in England between the organisations that meet health and care needs across an area. New analysis by IPPR and CF - a healthcare consulting and analytics company – reveals that unequal levels of integration currently present in the country mean that:

  • There are almost nine times as many delayed discharges per 1,000 bed days in Norfolk and Wavey ICS compared to Sussex and East Surrey ICS.
  • The maternal mortality rate is 16 times higher in the Sussex and East Surrey ICS than it is in the Suffolk and North East Essex ICS.
  • People with severe or complicated mental health problems in Bath and Northeast Somerset, Swindon and Wiltshire ICS are three times more likely to have a care coordinator than those in Leicester, Leicestershire and Rutland ICS.
  • Children with a mental health emergency in Birmingham and Solihull ICS are 80 per cent more likely to be seen by a mental health specialist within four weeks compared to children in Gloucestershire ICS.
  • Patients in North London ICS are 81 per cent more likely to say they lack access to sufficient support from local health and care services compared to patients in Dorset ICS.
  • The rate of foot amputations for every person with type two diabetes is 2.6 times higher in the in Northamptonshire ICS than it is in the Lincolnshire ICS.
  • See chart in notes for national integration variation picture.

Improving integration could help close these gaps across the country. The analysis also found that if all ICSs matched the outcomes seen in the top 25 per cent most integrated ICSs, it could mean:

  • 42,600 bed days saved in hospital due to fewer delayed discharges
  • 63,300 additional people with complicated mental health problems receiving a care plan
  • 68,600 potential fewer A&E attendances by people with mental health problems

IPPR stresses that these inequalities will only be narrowed if Integrated Care Systems have the capabilities and resources to develop a strong culture of collaboration. Culture, not structure, ultimately determines integration, according to IPPR. This will be critical to the government turning its legislation, and funding from the new Health and social care levy, into better patient outcomes in time for the next general election, says the think tank

To improve the legislation and ensure structural change is matched by the capability and culture to collaborate, IPPR proposes the following alongside the bill:

  • Developing services – A community health-building fund for local authorities should be established to improve non-NHS local services that improve health, so the NHS has world leading establishments to collaborate with. The fund should be targeted at the areas with the starkest health inequalities.
  • Developing leadership – ICSs should introduce leadership development programmes to help more health leaders think in ‘systems’ rather than their existing ‘silos’.
  • Upgrading digital – Data sharing within and between health care and social care organisations should be boosted with a multi-year funding pot put aside as part of the NHS capital budget. IT interoperability must be a priority.
  • Ensuring accountability - Patients should also be represented on ICS boards. Instead of expanding the executive powers of the health secretary to direct NHS England, more powers should be given to local leaders, parliament and citizens panels for scrutinising spending, decisions and integration efforts.
  • Better social care - the government’s funding for social care is a step in the right direction, but the £5.4bn over three years falls far short of the £6bn a year IPPR say social care needs. A ‘long term plan’ to improve the quality of social care services is urgent.

Dr Parth Patel, IPPR Research Fellow and an NHS doctor, said:

“A record £36 billion investment paired with major structural reform in the NHS and social care must ultimately be judged on whether they improve outcomes for patients. The Health and Care Bill is promising, but getting health and care services to work together better depends at least as much, if not more, on culture as it does on structure. A culture of collaboration cannot simply be bottled and shipped – but it can be shaped. The government should do more to empower local leaders to drive the creation of a truly connected health and care system.

“People and communities need better ways to hold the health service to account. At a time when the NHS is critically stretched, it cannot afford to another restructure that does little to improve sustainability and patient outcomes. This must be a turning point for health and care.”


Dr Parth Patel, the report’s author, is available for interview


David Wastell, Head of News and Communications: 07921 403651 [email protected]

Robin Harvey, Digital and Media Officer: 07779 204798 [email protected]


  1. The IPPR paper, Solving the Puzzle: Delivering on the promise of integration in health and care by Parth Patel, is available to download at:
  2. Figure 1: Variation in integrated care outcomes between ICSs

Source: CF 2021

Notes: Value above 0 indicates Integrated Care Index is above national average, value below 0 indicated Integrated Care Index below national average. Based on data from March 2019 to March 2020 - see appendix for methodology

  1. The Integrated Care Index was developed by Carnall Farrar and IPPR. The index is composed of 23 of metrics that reflect two or more organisations working together to deliver integrated care across three major fault lines: health care and social care, mental care and physical health care, and community care and hospital care. The index measures patient outcomes, patient experience and population health outcomes that high quality integration should lead to – rather than measuring integration as a process by assessing ICS governance. An index value above 0 indicates integrated care outcomes above national average; a value below 0 indicates integrated care outcomes below national average. All data is from March 2019 to March 2020. Data sources include Hospital Episode Statistics, NHS England, Public Health England and GP Patient Survey.
  2. IPPR is the UK’s pre-eminent progressive think tank. With more than 40 staff in offices in London, Manchester, Newcastle and Edinburgh, IPPR is Britain’s only national think tank with a truly national presence.