NHS Employers launch new ICS guide for integrated working

NHS Employers has released a new guide to support staff with integrated workforce thinking and delivering ICS strategy.

The guide was created with one of the main purposes of ICSs in mind: to improve outcomes in population health. It seeks to support ICSs to “deliver personal, person-centred care to their local populations now and in the future, offering insights and advice for ICS leaders to consider what is needed to further integrate their workforce.

It was developed in partnership with NHS Employer, Skills For Care (SFC), and the Care and Health Improvement Programme, a collaboration between the Local Government Association and the Association of Directors of Adult Social Services.

The guide begins by describing integrated workforce thinking as “leaders across systems work(ing) together to consider population health, health and care needs and their system strategy.” Through this, an effective workforce can be achieved that delivers better population health outcomes and more person-centred care within communities.

It notes how a successfully integrated workforce provides a positive experience for staff as well as its service users. This success can be achieved when health, social, and voluntary sectors work together with local partners and ensure the people in their communities are at the centre of the care they deliver.

The guide concludes that this way of working can be achieved through relationships that “create a culture and workforce that champions integration and the opportunities that it provides for both the people who draw on care and health and staff.”

The guide introduces a “checklist of readiness” for care systems to consider to “help ensure that partners are aligned and have a clear shared purpose, vision and agreement on the outcomes they wish to achieve together.”

The checklist includes:

  • Understand the vision of an integrated workforce. The guide suggests that they have a collective definition of workforce that is “shared and understood, and which includes both registered and non-registered professionals, service areas and statutory and independent workforce.” Doing this will allow a complete picture of the complete workforce across the system, and ensure it is making the best use of its resources and knowledge base.
  • Who needs to be involved? The guide suggests that ICSs consider appointing someone who “has the capability and capacity to develop an integrated workforce plan, implementing it and monitoring deliver.” It further asks if trusts have leaders or champions who can “challenge themselves to work in different ways and provide the leadership to inspire others to do the same.”
  • Develop an integrated workforce plan. Here, the guide advises that ICSs consider how they will evaluate the impact of the newly integrated workforce in terms of accessibility and quality of services, and how it has impacted the experiences and outcomes of its service users. The guide also urges ICSs to ask themselves how their integrated workforce plan will be developed in line with their system or place-based vision.

The guide moves on to presenting some collated ideas for ICSs to use for introducing integrated workforce thinking. It breaks these ideas down in terms of separate ideas and solutions for a successfully integrated workforce.


Firstly, the guide covers governance arrangements to ensure collaborative working across the systems.

One suggested tip is to set up and agree on a transparent framework and system of governance that can incorporate risk share and clear ownership over each aspect of the workforce. The guide also suggested that ICSs consider how to incorporate checks and challenges to ensure agility in the process of integrating its workforce.

It advises ICSs to not overcomplicate decision-making, and to “agree how you will prioritise as a team by concentrating on something that is important to everybody, for example, getting people home.” This can streamline decision-making and policies that can be agreed on by each aspect of the system.

The guide moves on to suggest using digital tools and solutions that can support the development and implementation of its workforce plan. Virtual wards and digital care plans will allow ICSs to work more collaboratively and remotely, and smooth the process of integrating different departments of the ICS system. To help with all aspects of its governance, the guide advises that ICSs identify “a cross-sector project team to lead the development of the thinking and planning.”

Changing cultures

The guide explains that “historically, organisations within systems have been working in silo, so it is important that culture change is addressed from the offset”. It adds that the culture of working is an integral part of building up an integrated workforce and that by focusing on changing it and developing it, it will be quicker and easier for ICSs to implement integrated working.

One tip in this section is to “focus on culture change in systems by listening and engaging with leaders from each organisation to agree on how integration can be achieved at a system level.” By doing this, the guide hopes that feedback gathered from service users and staff can be used to address concerns and issues as they begin to move towards integrating. The guide continues by presenting a tip on how this would be possible, saying that ICSs should “encourage proactive contact between colleagues across the system who have similar roles”.

It moves to suggest that a better understanding of a system’s ICS strategy and population data will give ICSs a better working knowledge of how these can impact ways of working together and future policies.

In another tip, the guide it advises that systems “take time to build relationships to understand who is who, what each other’s contributions are and how organisations can work together best”, in order to deliver better quality care and support the overall population health.


As part of its changing culture advice, the guide offers advice on how to develop its communication, explaining that “communication is key to developing a shared understanding of what an integrated workforce looks like”, and acknowledging the importance of sharing learning continuously as each system works towards a new way of working.

One of the main pieces of advice it offers is that communication must take place across the system at every stage of the process both internally and externally. Doing this will ensure feedback comes not only from staff but from service users as well. It will also ensure that knowledge will be shared as the system moves towards integrating completely.

The next tip is to “celebrate success and share learning from what has worked locally, within the system and nationally”. Doing this can give systems wanting to integrate an idea of what can be achieved. The guide acknowledges there is “not a one-size-fits-all solution for ICSs”, but the hope is that sharing and celebrating what has been done and learned through other ICSs can positively influence systems working towards an integrated workforce.


The final area the guide offers advice on is around data. It begins by emphasising how “data is crucial to integrating workforce thinking, to provide a shared understanding of the challenges across systems.”

It goes on to explain that using data and information gives ICSs insight on the local communities, and shows possible future demands for care and support in their area, along with potential patterns in workforce issues.

One of the main pieces of guidance it offers for ICSs is for them to ensure that they have a clear understanding of the current and future health, care, and support needs of the local population, using POPPI (projecting older people population information) and PANSI (projecting adult need and service information). It highlights how systems need to identify where the local workforce demographics can be obtained with other pieces of data, using sources such as the Office of National Statistics or NHS Digital.

To assist with data gathering and presenting, the guide suggests having a data lead to collect information and share it across all the partners within the ICS. It advises that ICSs need to demonstrate how data analysis has informed any future decisions, and highlight any potential biases in the data gaps.

The guide also discusses the health and care challenges that can impact integrated workforces, explaining that “to support workforce thinking, an integrated workforce plan must be aware of and address the key issues”.

Two such issues, recruitment and retention, are highlighted by the guide along with some advice on tacking these problems. It states that “workforce planning needs to be coordinated nationally across health and social care to ensure we have a sustainable workforce for the future”, not just in integrated thinking for healthcare settings.

The guide also identifies the need for “digital information and assistive technology needs to be explored further to identify opportunities”, using the example of a digitised care record so a patient only needs to tell clinicians and care staff their personal information once, which the guide explains “will provide more time for meaningful interaction with people who draw on care and support.”

Read the full guide here.