• There is broad consensus that trusts and their partners need to work collaboratively to make best use of limited resources and to integrate care for patients. The forthcoming ten-year NHS plan creates a pivotal moment for the national bodies to engage the sector and provide clarity on the desired 'end state' for STPs and ICSs in order to achieve this.
  • All trust boards are investing considerable time in collaborative working arrangements via STPs and ICSs. However we know that systems across the country are at different stages of their journey. We need to recognise those differences and ensure that every system has access to appropriate support.
  • The national bodies, and partners within local systems, must maintain clarity about what can, and cannot, be delivered within the existing legislative, regulatory and governance frameworks. Although systems that are progressing well will, rightly, welcome additional autonomy we must ensure that those local systems willing to pioneer new ways of working are not expected to take on undue levels of risk. 
  • Based on our conversations with trusts we know that success is usually based on sound and trusting relationships between a 'system' leadership team which has the capacity to work together. Within this, full engagement with local authorities and primary care remains of central importance.
  • Despite considerable diversity in the approaches of individual ICSs and STPs, a series of helpful characteristics are emerging in successful systems including:
    • agreeing a system level vision, strategy and plan, underpinned by a culture where system level working is the norm and sits comfortably with an institutional focus
    • the emergence of new governance and commissioning structures which support a population health management approach
    • developing new, integrated care models for smaller population units
    • embracing public engagement; and seeking to establish a means of constructive challenge to system plans via trust non executive directors, CCG lay members, councillors
    • beginning to move towards a single health and care leadership team in a local system and considering how to manage budgets and performance at a system level.