What we learned as an ICS – and why we need to ‘softwire’ our future local health and care systems

This year has been a time of transformation, and the winds of change feel particularly strong. Wherever you look organisations are changing fast – from radical restructuring in NHS integrated care boards (ICBs) and trusts, to local government reform, to the impact of unprecedented financial pressures on the voluntary sector. Right now, it seems that almost everyone is busy implementing some form of organisational change.

In the East of England, running cost reductions meant that from April 2026, six ICBs were replaced by three smaller organisations with refocused roles and larger footprints aligned to two new mayoral authorities: Norfolk and Suffolk, and Essex. Local government reform is replacing the current network of county, district, city and borough councils with a significantly smaller number of new unitary authorities – single councils responsible for most local services. The voluntary sector is changing too, and we have even seen the collapse of some local providers.

Change across so many organisations at the same time effectively means that we are entering a new era as health and care systems. In Suffolk and North East Essex, it means the end of a decade as an integrated care system (ICS) with stakeholders now moving into new systems.

In Suffolk and North East Essex, the integrated care partnership (ICP) was jointly led by three co-chairs from the ICB and county councils. A dedicated ICP function was a defining feature of the local system, driving partnership working and system leadership. In 2025 NHS England gave the ICB an ‘outstanding’ performance rating – the only ICB in the country at the time to achieve this – and highlighted its strong system leadership, and established and effective cross sector partnership working.

However, in 2025 Karyn Smith MP, Minister of State for Health, confirmed that ‘ICPs will no longer be a statutory requirement and therefore abolished’. The government says it remains committed to partnership working, although we have yet to understand how system working might look in this new era for health and care.

With change also comes opportunity. Mayoral strategic combined authorities, refocused ICBs, new unitary authorities, integrated health organisations and the voluntary sector will all have their part to play. As we come back together as new partners around new tables there is the potential to reset and renew how we could work together beyond the parameters of ICSs.

As these changes take effect, it feels important to reflect on what we learned as ICSs. In Suffolk and North East Essex, local leaders have been mindful that while they may have their heads down with organisational change, they should also have their heads up and consider wider system change too. Their collective reflections – and perspectives from some national external organisations – have been brought together in an ICS learning and legacy report.

The report describes five areas of action where stakeholders thought the ICS had delivered benefits that then drove improved outcomes for the population:

• Bringing partners together in new ways – cross-sector collaboration at system, place, neighbourhood and through professional networks.

• Sharing resources and data – through system approaches to finance, shared care records, linked data and anchor institutions.

• External and internal investment – enabling major digital, estate and workforce transformation programmes, creating capacity for innovation.

• Hearing every voice – embedding coproduction and lived experience, and pioneering inequalities programmes such as ‘Uncomfortable Truths’.

• Improving population health outcomes – using outcomes-based approaches.

Stakeholders also reflected on how local challenges of non-coterminous boundaries had created friction and complexity, alongside the impact of demographic and socioeconomic pressures.

Overwhelmingly, local stakeholders felt that our collective learning as an ICS was about the importance of paying real attention to how our health and care systems are ‘softwired’ by authentic human relationships, a sense of belonging, shared values and purpose. They highlighted seven lessons that were critical for the success of future systems:

1. Build the system on shared values, principles and relationships.

2. Start with purpose (‘Start with why?’) before designing structures.

3. Create inclusive spaces that build belonging, trust and understanding.

4. Actively redistribute power, especially to voluntary sector partners and communities.

5. Focus on leadership culture, not just governance.

6. Enable transformation to evolve, not be forced.

7. Nurture a healthy ecosystem where innovation can thrive.

At such a time of significant organisational change, there is a very real risk that we focus only on how we are ‘hardwired’ as health and care systems. Yet our learning demonstrates that committees and contracts, performance, processes and protocols are the wrong tools to begin with if we want to build effective future health and care systems.

As we enter this new era together as reshaped NHS, local government and voluntary sector partners, we potentially have a unique opportunity to rethink how we work together. This must begin with meaningful investment in how our health and care systems are softwired. We need to rebuild our systems from the inside out through a culture of trust, kindness and compassionate systems leadership. If we get that right, the rest will follow.