For decades, the legislative framework governing health and care in England has centred around the principle of competition between organisations to improve the quality of services. Yet there is now wide recognition that we need to look to collaboration and integration to improve population health, deliver better quality care, and make more efficient use of resources. 

The NHS Confederation welcomes this move, the importance of which is further reinforced by experiences of coping with a pandemic. While COVID-19 has proven to be the greatest challenge that NHS and local government services have faced in their history, it has also demonstrated what can be achieved when we move away from individual organisations working in silos and towards true collaborative working within systems. 

Over the coming 12 months, the government is expected to table new primary NHS legislation that will set out a legal framework through which NHS organisations will continue to work together and with others as integrated care systems (ICSs), to deliver the ambitions of the NHS Long Term Plan. 

To support the development of new policy and legislation relating to the future of systems, the NHS Confederation has undertaken an extensive six-month engagement process with our members
across England.

This report outlines the key findings from this engagement and sets out recommendations for the changes to national policy and legislation.