Integrated care systems (ICSs) are poised to take their place in the spotlight.

The local partnerships of organisations that have come together to plan and deliver joined up health and care services turn statutory next month.

But fledgling ICSs will be under significant pressure to deliver improvement at a turbulent time for the economy and local places, and for public sector funding.

Having the right resources will be critical, and a common view within local government is that many of the new systems' ambitions are unlikely to be reached without sustainable social care funding.

And concerns have been raised at a Health and Social Care Committee meeting about ICSs becoming ‘cabals of self-interest'.

So can ICSs provide what vice president of the Association of Adult Social Services Beverley Tarka described at The MJ's Future Forum last month as the necessary ‘shifting of the dial from crisis to prevention and early intervention', despite the significant challenges ahead?

Delving into that question, a recent Health Devolution Commission virtual roundtable on developing ICS best practice highlights that the relationship between health and local government must be close and aligned if any progress with the health inequalities agenda is to be made.

Will health inequalities avoid being marginalised as ICSs take up the reins?

Professor Michael Marmot, the director of the UCL Institute of Health Equity and one of the world's most eminent health inequalities experts says: ‘We need leadership from the top, and we need community voices.

‘The leadership from the top from local government as well as from ICSs is absolutely key to avoiding this vital agenda being pushed to the margins.

'Yes, we've got to deal with the [NHS] backlog, yes people need treatment.

'But this is an agenda that we've pushed to the side for too long.'

Focusing on the Government's flagship levelling up agenda, he adds that it is not enough to solely target the poorest, most left behind communities for health and wellbeing interventions.

‘The issue is the gradient.

'All of those below the very top have worse health than those at the top.

‘We calculated that if you assume that everyone who is not in the least deprived decile could have the same low mortality as people in the top decile, in the nine years from 2011 to 2019 we could have prevented one million deaths.'

Levelling up has to be ‘for whole communities, for everybody', he concludes.

Chair of the event Mayor of Greater Manchester Andy Burham offers a ‘sneak preview' of a review of the impact of five years of health devolution in his region.

Has it achieved anything?

The key findings may augur well for a similarly focused effort by ICSs on tackling health inequalities.

He says health devolution has led to a ‘joining of the dots between health and all the other policies at a local level - the bringing together of a single approach around population health'.

‘The headline conclusion from it is that "Greater Manchester had better population health than expected following devolution.

The benefits of devolution were apparent in the most deprived and poorer health areas, suggesting a narrowing of inequality".'

Mr Burnham says that what Greater Manchester has begun to do is ‘obviously something that is available to everywhere through these reforms'.

He adds: ‘I think there is evidence there that says the more we break down the silos and work more as a system, and work with communities in a place-based way, there is evidence we can change things from a health inequalities point of view.'

How are the largest NHS trusts tackling health inequalities and what role are they likely to play in future as ICSs become statutory? 

Dame Jackie Daniel is a member of the Shelford Group – a collaboration between 10 of the largest teaching and research NHS hospital trusts – and she is chief executive of the Newcastle Hospitals NHS Foundation Trust.

She says the Shelford Group refreshed its strategy last year, and health inequalities ‘and our role as anchor collaborators [locally] was centre stage'.

‘We agreed that we all had a core role of providing high quality healthcare, but if that's all we did we wouldn't shift the dial in the way that we now need to.'

She adds that the benefits of ‘just having this integration' were seen during the pandemic, ‘through work with care homes for example, where we've got, in Newcastle, some of the lowest mortality rates as a result of working so closely with our care home sector'.

The connection with local government has got to be a core one, she adds.

Are ICSs going to strengthen those links?

‘It's happening in Newcastle because of the deep trust in the relationship that we built between the city council and partners.'

But she concludes that how local relationships are going to play out more widely is unclear: ‘The jury's out a bit.

'I'm just going to be honest about how we'll be able to do that over time.

'But I do think organisations like the Shelford Group can play a big part in turbocharging some of this work as the Integrated Care Boards mature.'