IMPOWER - The evolving role of county authorities in Integrated Care Systems

This report, produced by IMPOWER, assesses how county authorities are engaging with England’s new Integrated Care Systems (ICSs), providing the first council ‘stock take’ on the development of these new structures.

It reviews governance, strategic planning and dynamics between local government and the NHS following the formal establishment of ICSs in July 2022.

The report finds cautious optimism amongst county and unitary councils about the potential of ICSs, but highlights substantial variation in local arrangements, unresolved structural tensions, and a need for clearer national policy alignment.

County authorities often see ‘place level’ partnerships as the most meaningful arena for integration, yet face challenges due to unclear delegation, NHS‑driven priorities, and complex governance burdens.

The report identifies risks of disengagement unless ICSs evolve towards genuine partnership working that reflects local priorities, supports prevention, and contain a core role for local authority leaders.

A survey of county councils and unitary authorities for the report reveals:

• County Councils Network (CCN) member councils reported 79% increased time commitments due to ICS engagement, with over a third describing this as significant.
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• Only 18% of councils felt confident their ICS had a clear process for monitoring outcomes.  
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• 73% of councils considered ‘place‑based’ partnerships more important for delivering priorities than the ICB.  
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• 52% of councils said partnership working had not noticeably changed since ICS creation.

Recommendations to government and ICSs in the report include:

• Reduce central targets and mandated activity to enable locally driven strategies.  Strengthen local accountability within ICSs, including through future devolution.
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• Clarify the role, powers and delegation of place‑based partnerships.
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• Agree a small number of shared, deliverable system‑wide ambitions through ICPs.  
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• Improve ICB governance, including joint oversight of major decisions and clearer management of conflicts of interest.
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• Align and rationalise roles of ICPs and Health and Wellbeing Boards to avoid duplication.

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