Our first blogs set an agenda for integrated care and ICSs. Please find summary and blog index below

Integrated care is essential for improving patient outcomes for younger people with serious health problems and for older patients. Patients with long term conditions (prevalence rise of 20% likely over the next  decade) need continuity with longer term care pathways. The alternative is rising numbers of emergency admissions - often with poor results for patients and their carers and frustration for NHS staff.

Integrated care is essential for the financial stability of the NHS. Investment in out-of-hospital care including virtual support is affordable. There is not the staffing nor the funding available for a net expansion of acute hospital bed numbers. The 48-hospital programme is highly selective in location and mainly composed of replacements.

Each Integrated Care System must have the confidence and drive to make primary and integrated care an effective partner to secondary care  with new joint programmes and joint staffing. This is the chance to deal with a very old problem - the division in British medicine.

NHS England has already set a target of reducing outpatient attendances by a third. To this should be added targets for a 15 per cent reduction in emergency admissions and a 15 per cent reduction in A&E attendances over the next decade. There could be a productivity rise of 20 per cent over the decade in elective procedures building on the great achievements of surgical teams with shorter stays and less invasive treatments.

Integrated Care Systems will need a management team which can drive progress using local resources in health and social care. Instead of the language of "crisis" we need actions for investment and development using the potential  for local initiative and local knowledge of patients and their needs. 

Among the specifics for ICS development we recommend:

• a strong research base for primary and integrated care.
• a single capital fund for each ICS to cover new builds, maintenance and innovation across health and social care. 
• skill development with shared programmes across primary and secondary care. 
• a new role for the District General Hospital as a community hub. (The last acute service strategy was in 1969.) The NHS needs to develop a hospital service not hospital sites.   
• high productivity elective care centres on the model of SWLEOC in South London.
• development of new kinds of integrated service in home care.
• development of the key role of PCNs and GPs as leaders for integrated care and community based diagnostics. The North and the Red Wall are well placed here - according to the CQC the best primary care is North not South.

To deliver on this agenda Integrated Care Systems will need a powerful team with a sense of mission for their local population. The Chief Executive should be the voice of the NHS locally and the leader in creative use of resources in the  new era. After all the NHS is already by far the largest spender and employer in the nation.