Role of an Integrated Care System during COVID-19 and beyond: a qualitative study with recommendations to inform future development

Abstract

ObjectiveIntegrated Care Systems (ICSs) have recently been implemented across England to better meet health and social care needs through partnership working between clinical commissioning groups, local authorities, and health and social care providers. This qualitative study aimed to explore insights into the COVID-19 response at an ICS level and inform recommendations for ICS development.Methods and analysisInterviews and focus groups were conducted with 19 senior health and social care professionals who were members of one ICS. A reflexive thematic analysis was conducted to develop key themes and recommendations for ICSs.ResultsWorking together across health and social care, responding to a prolonged crisis, managing expectations and developing the ICS formed the four master themes. Notable subthemes included changing professional roles and responsibilities, communicating and coordinating COVID-19 guidance, the availability of system resources, the local versus national contexts and a need to combat health inequalities.ConclusionThe unprecedented crisis of COVID-19 moved health and social care partners to work together like never before, and at a very quick pace. Our findings confirm that intentional collaboration must be maintained in leading and delivering effective ICSs. ICS partners, together with the public, must now agree a shared vision for health and social care as a priority. A long-term focus to improve population health and reduce health inequalities will require a cultural shift and will place a new type of demand on resource allocation and sourcing. It will also demand public health leadership, a fully coordinated infrastructure, and comprehensive, ongoing evaluation. In parallel to this, the well-being of the health and social care workforce will need to be addressed to build upon the lessons of COVID-19.

Integrated care system leadership: a rapid realist review

“…The lack of this clear vision contributes to management challenges (Aufegger et al, 2020;Aunger, Millar, Rafferty, Mannion, et al, 2022;Harlock et al, 2020;Kozlowska et al, 2020;MacLeod et al, 2019;Martin, 2021;Miller and Stein, 2020;Round et al, 2018;Sims et al, and measuring ICS priorities (Sims et al, 2021). Empirical literature underscores involving all stakeholders, including the public, in setting local ICS priorities, especially in early integration stages (Bell et al, 2022;Gordon et al, 2020;Harlock et al, 2020;MacLeod et al, 2019;Martin, 2021;Miller and Stein, 2020;Mitchell et al, 2020;Nicholson et al, 2018;Round et al, 2018;Urtaran-Laresgoiti et al, 2018). This involvement aims to address broader ICS goals like population health, illness prevention, and reducing health inequalities.…”

“…After screening the initial 5,716 records by title and abstract, 99 records were screened by full text. In total, 22 records were evaluated for relevance (Alonso and Andrews, 2022; Aufegger et al , 2020; Aunger et al , 2022b; Bell et al , 2022; Chang, 2021; Elliott et al , 2020; Embuldeniya et al , 2018; Gordon et al , 2020; Harlock et al , 2020; Kozlowska et al , 2020; MacLeod et al , 2019; Martin, 2021; Martin and Knowles, 2019; Miller and Stein, 2020; Mitchell et al , 2020; Nicholson et al , 2018; Pearson and Watson, 2018; Robert et al , 2022; Round et al , 2018; Shand and Turner, 2019; Sims et al , 2021; Urtaran-Laresgoiti et al , 2018) and 1 was excluded (Alonso and Andrews, 2022) resulting in 21 being included for richness assessment. Three studies were excluded following a review of richness (Elliott et al , 2020; Martin and Knowles, 2019; Robert et al , 2022), the remaining 18 papers were reviewed for rigour, considered trustworthy and therefore included in the review.…”

“…A shared culture is essential for collaborative working, facilitating common goals and a unified narrative (Bell et al , 2022; Harris et al , 2022; Urtaran-Laresgoiti et al , 2018). Cultural alignment reduces conflict and supports shared values and vision (Cheng and Catallo, 2020; Nicholson et al , 2018).…”

“…The literature underscores recognising historical power and resource imbalances between health, social care and the voluntary sector as crucial for developing collaborative relationships (Chang, 2021; Gordon et al , 2020; Martin, 2021; Sims et al , 2021). Trust, fostered through frequent interactions and face-to-face meetings, is vital, as is resolving tensions to maintain trust and collaboration (Aunger et al , 2022b; Bell et al , 2022; Embuldeniya et al , 2018; Harlock et al , 2020; MacLeod et al , 2019; Miller and Stein, 2020; Nicholson et al , 2018; Shand and Turner, 2019).…”

“…There was empirical evidence of the need for real-time data sharing across partners and an acknowledgement that this was limited by a lack of shared systems or information governance requirements (Embuldeniya et al , 2018; Pearson and Watson, 2018). The development of shared data systems, or intelligence dashboards, which can be used at all levels to support delivery to local communities (Bell et al , 2022; Gordon et al , 2020; Mitchell et al , 2020; Nicholson et al , 2018), was therefore seen of importance to support leaders in using intelligence to target interventions. (Bell et al , 2022; Gordon et al , 2020; Mitchell et al , 2020; Nicholson et al , 2018):…”