Article Text

Download PDFPDF
Integrated care systems in the English NHS: a critical view
  1. Sally Ruane
  1. Health Policy Research Unit, De Montfort University, Leicester, UK
  1. Correspondence to Dr Sally Ruane, Health Policy Research Unit, De Montfort University, Leicester LE1 9BH, UK; sruane{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


The intriguing evolution of health policy in recent years has implications for all parts of the health system. With the UK falling behind most high-income countries on many measures of child health1 and growing evidence of a worrying health gap between UK children in deprived and affluent areas,2 paediatricians and others working in child health will want to remain abreast of the broader policy backdrop even where child health has not been privileged in policymaking. While the 2012 Health and Social Care Act reinforced the fragmentation of the service through multiple providers in competition with one another, subsequent policy promises local collaboration and joint working. This article traces this evolution and asks what it means.

Moving from market fragmentation to integration

The 2012 Health and Social Care Act required competitive processes in contracting for healthcare between commissioning bodies and provider organisations. During the troubled passage of the legislation through parliament, opponents, including some paediatricians, raised numerous concerns. Among these were the cost and distraction of an unnecessary reorganisation, the transaction costs inherent in any market structure entailing expenditure which does not contribute to improving healthcare, the certainty of increased privatisation since regarding the National Health Service (NHS) as ‘preferred provider’ was now outlawed and the weakening of professional collaboration in a competitive environment.

The Act exacerbated fragmentation and disregarded the benefits of greater interorganisational and professional cooperation but this began to change with the appointment of Simon Stevens as chief executive (CE) of NHS England (NHSE). Stevens’ 2014 Five Year Forward View (FYFV)3 set out a vision for further service reorganisation around ‘new models of care’. Stewart Player4 has argued that the FYFV is drawn directly from the ideas developed in a 2012 international project under the auspices of the World Economic Forum. Stevens (then Global Division head in UnitedHealth Group, the USA’s largest …

View Full Text


  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.