From the long term plan to the prevention green paper, various policy initiatives have restated the ambition for the NHS to play a stronger role in prevention and public health. COVID-19 has brought to the fore the impact of health inequalities, and there is increasing pressure on the NHS to make a meaningful contribution to the population health agenda. As the public health system evolves, there is an opportunity to articulate the contribution of the NHS to prevention and public health and the role of health and care organisations, including trusts play as anchor institutions creating economic and social value for local communities. Integrated care systems have been defined as the desired mechanism for NHS and other bodies to work together to improve the population’s health, with system partners working together to make shared decisions about how resources are used to improve people’s health. Most recently, the white paper proposes a new statutory partnership of NHS, local government and wider partners to focus on tackling health inequalities and improving population health – alongside a duty to collaborate and promote the ‘triple aim’ of better care for all patients, better health for everyone, and sustainable use of NHS resources.

The 2021/22 NHS England and NHS Improvement operational priorities letter sets out a focus on addressing the health inequalities that COVID-19 has exposed, describing how "systems will be expected to make and audit progress against the eight urgent actions set out on 31 July as well as reduce variation in outcomes across the major clinical specialties and make progress on reducing inequalities for people with learning disabilities or serious mental illness, including ensuring access to high-quality health checks."

The ICS agenda may then be a useful lens through which to look at the NHS’s contribution to population health as part of a wider system response to challenges at the region, place and neighbourhood level. Local health and care organisations embedding public health and prevention into their plans, including beginning to develop population health management systems, demonstrates the potential of system working. However, as they stand, systems act as a convenor for existing system partners to collaborate, rather than as a formal unit of delivery or commissioner of services. We may expect to see a more formal role for ICSs in prevention and public health as ICS policy develops, and this will need to be considered carefully alongside planned changes to the national public health architecture, to ensure that accountabilities for public health outcomes and interventions are clear and well aligned.

As the public health system evolves, there is an opportunity to articulate the contribution of the NHS to prevention and public health and the role of health and care organisations, including trusts play as anchor institutions creating economic and social value for local communities.


The NHS white paper sets out how ICSs will be placed on a statutory footing, comprised of an ICS NHS Body and a separate ICS health and care partnership. While the proposals envisage the ICS NHS body will be responsible for planning and securing health services, including commissioning, the ICS health and care partnership will bring together health, social care, public health and potentially representatives from wider public services such as social care and housing providers. This body will be responsible for developing a plan that addresses the wider health, public health, and social care needs of the system – the NHS ICS body and local authorities will have to have regard to that plan when making decisions. This raises a number of questions about how these bodies will work together and enable close working between health and other partners, but signals a direction of travel towards a much stronger role for NHS organisations in population health.

Partnerships at a local level are critical in enabling people to live healthily, with decisions made by local government and other organisations having a bearing on whether an environment promotes or detracts from good health, with consequences for the NHS. This is the case across all policies. Sufficient stock of good quality housing, including social housing, reduces the risk of homelessness and helps to prevent respiratory illness from poor housing conditions. Transport infrastructure, with affordable public transport, enables people to participate in society and work, improving mental health, reducing social isolation, and encouraging physical activity. Local investment in business and enterprise reduces unemployment, boosts the local economy and encourages participation and engagement. NHS trusts, local authorities and other public services are anchor institutions, with influence in local communities and economies, a strong role in the local labour market, and thus can play a key role in influencing these drivers of good health provided the right enablers are in place.

An important element of the successful development of ICSs as a local forum for delivering public health is maintaining close relationships with local government and other non-NHS partners. System working offers an important opportunity for local government in its capacity for providing public health services, social care and wider services which contribute to health and wellbeing to work more closely with the NHS. Sustainability and transformation partnerships and (STPs) and ICSs across England have reached different stages of maturity of the relationships they have built between the NHS and its local partners. However, STPs and ICSs vary in composition, population size and geography. A local approach to implementing joint working is essential if integrated care is to be achieved in a way which meets the needs of diverse populations and deliver on its core aim of improving the health of the population. With local authorities responsible for other services which contribute to population health, it offers a chance for local systems to tackle health inequalities, address the wider determinants of health as part of a whole systems approach to prevention, and provide joined up services.