Role and responsibilities for integrated care system assessments

Page last updated: 23 February 2024

Our legal duties and the Secretary of State’s objective and priorities for this work.

The Health and Care Act 2022 gives us a new responsibility to provide independent assurance to the public of the quality of care in their area.

Our assessments will enable us to understand how integrated care systems are working to tackle health inequalities and improve outcomes for people. This means looking at:

  • how services are working together within an integrated system
  • how systems are performing overall.

Our reviews will take into consideration the core purpose of integrated care systems. This is referenced in NHS England’s design framework and the requirements of the legislation. They will focus on 3 themes:

  1. Leadership
  2. Integration
  3. Quality and safety

Secretary of State's objectives and priorities

Under the Health and Social Care Act 2008 (as amended by the Health and Care Act 2022), the Secretary of State can set objectives and priorities for our assessments of local authorities and integrated care systems. These can sometimes be revised when needed.

Secretary of State's objectives:

Each assessment should:

  • Identify what the integrated care system is achieving, with particular focus on the Secretary of State’s priorities for these assessments in relation to leadership, integration, and quality and safety.
  • Use qualitative assessment to complement quantitative data and refer to any relevant place-based, local, system-level or nationally-set strategies.
  • Support the integrated care system to reflect on its own performance and practice.
  • Examine how the integrated care system is reaching its outcomes, in particular to:
  • identify models of operation and changes in practice
  • highlight best practice and areas of concern.

Secretary of State’s priorities:


Priority: To understand how effectively the leadership of each integrated care system is creating and communicating a shared vision that responds to the needs of its local population, sustainably addressing both short-term pressures and longer-term goals. This includes assessing the following:

  • Is the integrated care system adequately considering the resource implications of its planned activity across the system, particularly regarding the workforce? Does this include taking a systematic approach to allocating and using resources effectively?
  • Is the integrated care system developing and implementing an effective strategy that addresses health inequalities within the population?
  • How effectively is the integrated care system considering the wider determinants of health in its strategies and how it delivers them?
  • When developing and implementing its activity, is the integrated care system adequately considering the voices of people who use health and care services and their families, carers and representatives? This includes those from under-represented groups.
  • Is the integrated care system adequately involving people with appropriate experience and expertise in its activity? This includes local children's leadership (including Directors of Children’s Services, Directors of Public Health, and Integrated Care Board executive leads with responsibilities relating to babies, children and young people).
  • Does the integrated care system ensure its plans, strategies and commissioning decisions adequately consider the:
    • health and wellbeing outcomes for babies, children and young people,
    • voices of children, young people and families
    • integration of children’s services?


Priority: To understand how effectively the organisations within each integrated care system are forming strong partnerships and integrating their leadership arrangements. This is to plan and deliver joined-up care and services designed around people, not organisations, and includes assessing the following:

  • Are all types of health and care services and supporting organisations able to have appropriate influence at place and system level to plan and deliver services?
  • Is the integrated care system adequately promoting and enabling collaboration between stakeholders? This includes those from services related to health and care, such as education and employment services.
  • Is the integrated care system:
    • strengthening joint processes
    • considering resourcing and capacity requirements across the whole journey for people using health and care services?

And does this adequately drive improvements, including those to support:

  • timely and appropriate discharge from health and care services
  • people to live independently in the place they usually live?

Quality and safety

Priority: To understand how effectively each integrated care system drives improvement of quality and safety at a system level. This includes assessing the following:

  • Does the integrated care system have effective systems to address quality and safety issues that occur when people’s care is shared or moves between different providers and care settings – both within the system and beyond it?
  • Does the integrated care system encourage providers, commissioners and related services and agencies to communicate safeguarding issues in a transparent way, both within the system and beyond it?