What are Integrated care systems (ICSs)?
Integrated care systems (ICSs) are organisations working together in an area to deliver health and care, and consist of an integrated care board (ICB) and an integrated care partnership (ICP). On the 1^st July ICSs became statutory through the Health and Care Act 2022.

There are 42 ICSs throughout England, each covering a distinct geographical area. They are made up of an integrated care board (ICB) which manages the day-to-day planning and running of the ICS (taking over a lot of the functions previously held by clinical commissioning groups, or ‘CCGs’) and an integrated care partnership (ICP) which brings together organisations within the local area concerned with the wider health and care of the local population.

Integrated care systems were set up with four primary goals:

• improve outcomes in population health and healthcare
• tackle inequalities in outcomes, experience and access
• enhance productivity and value for money
• help the NHS support broader social and economic development

Although respiratory care is not referenced explicitly beyond Targeted Lung Health Checks within the 2023/2024 planning guidance which sets out key NHS priorities for the year, it is a priority in the NHS’s Long-Term Plan. The importance of respiratory should continue to be recognised as ICSs develop. It is vital that ICBs include respiratory care within the joint forward plans they are producing and work to ensure people with lung conditions get the care and treatment they need.

What is the situation for lung conditions in your Integrated Care System?

The map below shows the 42 Integrated Care Systems throughout the country, and provides key statistics such as prevalence, the waiting list and the workforce for each. Select your local area to see key figures in your ICS:

A Flourish data visualization.

What should ICSs focus on to improve lung health?

The Taskforce for Lung Health will be looking to work with ICSs to ensure that lung health remains a priority throughout England.

We have created briefings for each ICS with detailed information about prevalence, outcomes for people with lung conditions and recommendations for what they could do to improve lung health in their area.

We know that every ICS is different and has specific population and workforce needs; however, Taskforce believes the following are relevant for all ICSs and will help them to meet these needs:

• Reducing the number of people who rely too heavily on short acting agonist beta (SABA) reliever inhalers and promoting the prescribing of preventer inhalers. 
  
  A survey by Taskforce member Asthma + Lung UK found that more than one in five people with asthma used six or more relievers a year. Their report – Fighting Back: Transforming Care in the UK– highlighted that overreliance on reliver inhalers can increase the risk of asthma attacks and lead to more people with asthma needing to be hospitalised.
  
  Best practice inhaler prescribing has the potential to significantly reduce SABA overuse, improve patient outcomes, and achieve more environmentally sustainable prescribing. For guidance on doing this as part of the IIF incentives please see here.
   
• Ensuring that the respiratory workforce is supported to deliver the best care, and that there are adequate numbers of respiratory specialists in every area. 
  
  One of the Taskforce’s members, the British Thoracic Society (BTS) produced a report on the healthcare workers specialising in lung conditions and respiratory care. BTS estimated that far more training places for respiratory specialists were needed, in addition to more respiratory nurses, physiologists, pharmacists and physiotherapists. The North East and Yorkshire Respiratory Clinical Networks have produced a webinar available here, where different areas showcased how they had tackled spirometry redevelopment challenges. 
   
• Ensuring the restart of spirometry throughout the country, to allow for accurate and timely diagnosis of respiratory conditions. Spirometry is a crucial part of ensuring that a diagnosis is correct.
  
  Guidance on the restart of spirometry from the British Thoracic society can be found here.
  
  In December 2022, the Taskforce for Lung Health facilitated a webinar on the Future of Spirometry, to discuss the barriers to providing spirometry within primary care, bust some myths, share best practice and identify solutions. The webinar can be viewed here.
  
  The North East and Yorkshire Respiratory Clinical Networks have produced a webinar available here, where different areas showcased how they had tackled spirometry redevelopment challenges. 
   
• Implementing the recently finalised pre-diagnosis breathlessness pathway for adults in England, which should speed up the diagnosis of lung disease for patients.
  
  The breathlessness pathway is designed to help provide consistency and guidance in establishing an accurate diagnosis as early as possible.

If you have any questions about integrated care systems or lung health in your local area, please get in touch with us at Taskforce@asthmaandlung.org.uk