Integrated health and care systems in England: can they help prevent disease?Integrated health and care systems in England: can they help prevent disease?

Abstract

Strengths and limitations of this study What is already known about this subject? ► The National Health Service (NHS) in England plans for the entire country to be covered by integrated care systems (ICSs) by April 2021. The aims of these local health and care partnerships are broad and include improving disease prevention and population health while maintaining NHS financial sustainability. Yet, the evidence for more integrated care leading to better disease prevention is weak. What does this study add? ► Although nearly all of the 2016 sustainability and transformation partnership (STP) plans included a prevention or population health strategy, the content varied widely, often lacked detail, and had little on population-level interventions affecting the social determinants of health. How might this impact on clinical practice or future developments? ► The 2019 STP and ICS 5-year strategic plans, and the roll out of ICSs across England by April 2021, provide an opportunity for local health and care services to work together more effectively to prevent disease and improve population health. ► In light of limited evidence on the relationship between integrated care and disease prevention, we describe how a more coordinated approach to tackling the social determinants of health across government could help. AbStrACt Objectives Over the past 12 months, there has been increasing policy rhetoric regarding the role of the National Health Service (NHS) in preventing disease and improving population health. In particular, the NHS Long Term Plan sees integrated care systems (ICSs) and sustainability and transformation partnerships (STPs) as routes to improving disease prevention. Here, we place current NHS England integrated care plans in their historical context and review evidence on the relationship between integrated care and prevention. We ask how the NHS Long Term Plan may help prevent disease and explore the role of the 2019 ICS and STP plans in delivering this change. Methods We reviewed the evidence underlying the relationship between integrated care and disease prevention, and analysed 2016 STP plans for content relating to disease prevention and population health. results The evidence of more integrated care leading to better disease prevention is weak. Although nearly all 2016 STP plans included a prevention or population health strategy, fewer than half specified how they will work with local government public health teams, and there was incomplete coverage across plans about how they would meet NHS England prevention priorities. Plans broadly focused on individual-level approaches to disease prevention, with few describing interventions addressing social determinants of health. Conclusions For ICSs and STPs to meaningfully prevent disease and improve population health, they need to look beyond their 2016 plans and fill the gaps in the Long Term Plan on social determinants. The idea that the National Health Service (NHS) should focus on preventing disease as well as treating it is nothing new, but the policy rhetoric regarding its role has been amplified over the past year. In November 2018, the Secretary of State for Health and Social Care published a policy paper describing the UK Government's 'vision' for prevention, which states that 'the NHS and local authorities need to put prevention at the heart of everything they do'. 1 This was followed in January 2019 with the launch of the NHS Long Term Plan-a blueprint for how the NHS in England will spend additional government funding over the coming 5 years-which, along with the subsequent implementation framework, emphasises the NHS's role in prevention and reducing inequalities. 2 3 Finally, the government's recent green paper (a policy paper for consultation) echoes the commitments of the NHS Long Term Plan. 4 These reports argue that little will be gained in disease prevention without closer working between NHS and non-NHS organisations, and without greater attention paid to social determinants of health, such as housing, education, and employment. Despite this, local governments in England who are responsible for spending on services that affect many of these social determinants faced a £3.