CEO blog - Can integrated health organisations (IHOs) deliver joined-up care?

For some time, I have been reviewing the articles around the development of IHOs. Whilst formal evidence is incomplete the NHS 10-year plan directs ICBs and NHS England to establishing them. Easier said than done especially given the current financial position the NHS finds itself in. However, the biggest barriers to success may not be organisational structures, contracts, or governance arrangements, but NHS organisational culture, accountability, and the strength of neighbourhood health services.

There are several critical issues:

  • Integration is hard to achieve through contracts alone.  Creating joined-up care across multiple organisations brings transaction costs, complexity, and financial challenges that fully integrated organisations can often avoid.

  • Accountability matters.  IHOs will need robust arrangements for local accountability and legitimacy, particularly when making decisions about both service delivery and resource allocation.

  • Primary and neighbourhood care are critical.  What evidence exists comes from other health systems. Evidence suggests integrated systems work best when shaped by strong primary care, not hospital-focused models.

  • Culture is as important as structure. True integration requires clinicians, managers, and teams to work differently across organisational and professional boundaries.

  • Robust functioning neighbourhood health services are essential foundations.  Without strong place-based services and effective support for people with complex needs, IHOs are unlikely to deliver their own ambitions or those in the 10-year plan. Public policy statements over the years of placing ‘the patient’ at the centre in structural diagrams have not consistently delivered integrated care in practice. The real challenge is creating the conditions, behaviours and relationships that make integration work every day.

Creating these conditions is still some way off in many parts of the system and there is limited evidence to date of who is leading this important work.

William Greenwood

Chief Executive