Purposes of an integrated health organisation

NHS leaders agree that the primary purpose of IHOs should be to improve population health outcomes and deliver better value for money by increasing allocative efficiency. By reducing competing financial incentives across services and sectors and overcoming fragmentation in how care is commissioned and delivered, IHOs are a way of enabling the NHS to shift more spending toward earlier and more cost-effective interventions and build services that better meet the needs of communities.

The specific outcomes IHOs are expected to deliver should be defined and incentivised locally by ICBs and providers. However, a small number of ‘big ticket’ outcomes that are set nationally may be beneficial. Outcomes may include lower cost per head of population, reduced health disparities, improved and more equitable healthy life expectancy and reduced avoidable mortality. Congruence between IHO outcomes and outcomes that feature in other contractual models is also essential, including the Quality and Outcomes Framework (QOF) in primary care and the neighbourhood provider contracts outlined in the 10YHP.

Healthcare leaders emphasised the importance of agreeing the purpose of an IHO up front to avoid misalignment after an IHO contract is awarded. There were concerns that tight financial envelopes may mean some organisations view IHOs as a route to secure more funding or autonomy, rather than as a mechanism for driving partnership working and directing resource to the correct place for the right outcomes. To succeed, the relationship between the ICB, the IHO host provider and partner providers must be collegiate, not adversarial. This will demand clear oversight arrangements and governance, aligned incentives and strong convening leadership from the ICB.

Becoming a host provider, in the words of one community trust leader, should not be seen as a ‘badge of honour’, but should be seen in the following terms: