The Government published a white paper, “Integration and innovation: Working together to improve health and social care for all” on 11 February 2021. This sets out proposals for changes in legislation with the aim of enabling integration within the NHS in England and between the NHS, local government and other health system partners. The proposals are grouped under four themes: working together and supporting integration; stripping out needless bureaucracy; enhancing public confidence and accountability; and additional proposals to support social care, public health, and quality and safety.

Every part of England will be covered by a statutory integrated care system (ICS). These will be made up of an ICS NHS Body and a separate ICS Health and Care Partnership, bringing together the NHS, local government and partners. The ICS NHS body will be responsible for the day to day running of the ICS, while the ICS Health and Care Partnership will bring together systems to support integration and develop a plan to address the systems’ health, public health, and social care needs.

The paper includes a triple aim:

• better health and wellbeing for everyone
• better quality of health services for all individuals
• sustainable use of NHS resources

The proposals follow an earlier consultation on building integrated care systems in England. Many of the proposals are along similar lines to what the NHS has been saying are needed. The emphasis on integration and the focus on better health and wellbeing for everyone is also welcome. Legislation alone cannot deliver good integration and there is general recognition that building good relationships will be essential to make the new structure work.

There are also questions being raised about the lack of patient representation or focus on coproduction in the proposals, whether they will represent an unnecessary upheaval at a time when the NHS needs to focus on rebuilding services, and the fact that social care and the future of public health are not included but will need to be addressed if the reforms are to work.

The Kings Fund has published their response to the earlier consultation, the Nuffield Trust has identified five traps to avoid and National Voices responded from a patient perspective.