Yesterday’s report from The King’s Fund, Integrated care systems in London: Challenges and opportunities ahead, finds that health and care organisations across London have worked together more closely than ever before to improve and join up services in response to the Covid-19 pandemic.

The new report, commissioned by London’s Mayor, looks at how London’s five integrated care systems (ICSs) – set up to enable joint working between the NHS, local authorities and community organisations – had been working before and during the first wave of the pandemic. It finds that Covid-19 created a clear common purpose that allowed health and care organisations to work together to shift how their services were delivered. In some cases, changes that would normally have taken years to achieve happened in the space of weeks or even days. The report highlights rapid changes enabled by this greater collaboration including:  

• massive leaps in remote access with many Londoners able to access virtual outpatient appointments and speak to their GP on the phone or by video 
• faster problem solving across organisations through frequent contact - meeting daily at some points in the pandemic - to find solutions such as sharing limited PPE supplies  
• closer work with voluntary and community organisations and local pharmacies to support people who were shielding 
• changes to services such as the creation of ‘hot’ and ‘cold’ hubs to separate patients with suspected covid-19 from non-Covid patients. This helped to keep Londoners as safe as possible while still delivering key services.

The report found that the temporary suspension of some national rules such as those around funding discharges enabled more integrated provision of care. 

However, the report also highlights the stark health inequalities that existed in the capital prior to the pandemic, with life expectancy varying between boroughs by as much as 15 years for women and 19 years for men, and that Covid-19 has exacerbated these health inequalities further among Londoners, including those from Black, Asian and minority ethnic communities, homeless people and people with learning disabilities.   

The report found that there is now strong commitment among London’s health and care leaders to pursue the reduction of health inequalities with greater vigour. The report’s authors propose that ICSs must now ‘seize the moment’ by strengthening collective action on health inequalities and play a key role in moving from aspiration to action on reducing health inequalities across the capital. The report recommends sustained collaboration at three levels: 

• Locally-led action on health inequalities should be co-ordinated by London Borough-based partnerships 
• Integrated care systems will play a crucial role in linking the work of the boroughs with London-wide initiatives and public health expertise 
• At a London level, partners need to revisit which areas will benefit most from a coordinated response across the capital and update them in light of the impact of the pandemic. For example, around health inequalities and the likely rise in demand for mental health services .

The report adds that, before service changes brought about by the pandemic can be made permanent, there needs to be adequate scrutiny, including public consultation and engagement.  

Richard Murray, Chief Executive of The King’s Fund and one of the report’s authors said: 

'One of the few silver linings from the pandemic was the big leap forward in joint working to deliver health and care across London. This allowed London’s health and care services to respond to the unprecedented challenges of Covid-19. However, Covid-19 also laid bare the deep health inequalities that blight the lives of many Londoners. London’s health and care leaders now need to use this momentum and sense of common purpose as a catalyst for tackling inequalities and addressing London’s health challenges.' 

The Mayor of London, Sadiq Khan, said:  

'It has been an extremely challenging year for our NHS and social care services as staff have gone above and beyond to help and care for Londoners. Covid-19 has devastated our city, but this report highlights how health and care organisations have worked together in the face of such difficult circumstances, and have importantly united to tackle health inequalities. The virus has had a disproportionate impact and widened the already unacceptable health inequalities in our capital, and I will continue to champion, challenge and collaborate with the NHS to ensure a fair and healthy recovery for all Londoners.'

1. For further information, or to request an interview, please contact the Press and Public Affairs team on 020 7307 2585 (if calling out of hours, please ring 07584 146035).
2. The King's Fund is an independent charity working to improve health and care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible health and care is available to all.
3. Analysis for the report was carried out in two phases: 
   
   The first phase was conducted before the outbreak, between January and February 2020. This explored the long-term plans and strategic priorities of London’s five ICSs, and how the partnerships had developed since our previous reports.
   
   The second phase was conducted after the first wave of Covid-19, between October and November 2020. This explored how partners in London had worked together to respond to the initial phases of the pandemic, and how Covid-19 has had an impact on the longer-term priorities for London’s five ICSs. 
4. Greater London Authority (2017). Better health for all Londoners: consultation on the London health inequalities strategy. London: Greater London Authority.
5. The report’s authors interviewed 27 health and care leaders across London for the report as well as holding a roundtable with 15 senior leaders. While this was largely drawing on the experiences at one level of the system it shows how this leadership facilitated much progress in integrated care during the pandemic. These interviews were coupled with documentary analysis of London’s five integrated care system’s long-term plans.