Integrated Care Systems (ICSs) have become the organising backbone of the English NHS in 2026. They now control around 70% of national NHS spending, coordinate the workforce, and are responsible for improving population health across millions of people. But the most important shift has not been structural — it has been behavioural.

The real question for 2026 is no longer what ICSs are, but how ICSs collaborate:
with neighbouring systems, councils, PCNs, providers, and increasingly with regional NHS partners.
And crucially, how MedTech, biotech, digital health companies, and pharmaceutical innovators collaborate with ICSs to redesign pathways and deliver measurable population benefit.

Both scientific evidence and financial pressures point to the same conclusion:
collaboration is now the essential operating model for ICSs.
The systems that collaborate — regionally, digitally, clinically, and with industry — are the systems that deliver better outcomes, better value, and greater resilience.

This 2026 guide explains how ICSs work together, why collaboration across boundaries is unavoidable, and how innovators can partner effectively with the NHS to support integrated, efficient and equitable care.
how industry must collaborate,
and the scientific rationale behind this shift, based on the strongest evidence available.

Why ICS Collaboration Is Now Non-Negotiable: The Scientific Case

The clearest evidence comes from the Imperial College graph-based clustering study — one of the most sophisticated analyses of NHS patient flow ever conducted. Using 109.8 million outpatient appointments, 20.9 million patients, 10,745 GP practices, and 199 trusts, the researchers applied Markov Multiscale Community Detection (MMCD) to show that the current ICS boundaries do not match how patients actually use services

Key findings that shape ICS collaboration today:

14.7% of all outpatient appointments occur outside a patient’s own ICS.
More than 16 million cross-boundary appointments take place each year.
Over 534,000 patients are registered with GP practices outside their ICS.
Data-driven “natural regions” reduce cross-boundary leakage by 37.5%.
The most stable natural configurations are 10, 7, and 4 larger regions, not 42 ICSs.

The scientific conclusion is unavoidable:

ICS boundaries are porous, patient flows are regional, and no ICS can function effectively in isolation.

ICSs must therefore collaborate:

with neighbouring ICSs
across regional networks
along shared clinical pathways
through common digital infrastructure
around shared workforce and capital plans

The science does not support isolation. The science supports integration at scale.

The Financial Reality: Collaboration Is the Only Path to Stability

The King’s Fund’s multi-year research shows ICSs face three structural pressures:
workforce shortages, rising demand, and persistent deficits

Even the most advanced ICSs cannot address these pressures alone.

Collaboration is financially essential because it enables:

shared risk management
regional capital planning
joint workforce pipelines
shared elective recovery capacity
cross-ICS winter planning
more coherent procurement
fewer duplicative digital systems

ICSs that currently operate as self-contained units tend to:

stabilise more slowly
overspend more rapidly
duplicate programmes
fragment workforce planning
lose system-level opportunities

The financial architecture of the NHS — control totals, productivity measures, elective recovery targets — is designed to reward regional cooperation, not fragmentation.

Regionalisation: The New Operating Model for ICS Collaboration

While not formally legislated (yet), ICS consolidation is already happening in practice:

Shared ICS executive teams
Joint provider collaboratives across entire regions
Regional elective recovery boards
Combined finance committees
Shared population-health analytics
Regional workforce hubs

This aligns exactly with the Imperial patient-flow evidence:
England naturally divides into 7–10 large care ecosystems, not 42.

In 2026, ICSs increasingly operate as:

local health systems at “place” level
coordinated collaboratives at ICS level
regional planning units across multiple ICSs

This creates the conditions for shared innovation, shared bidding, shared digital infrastructure — and shared partnerships with industry.

How ICSs Should Collaborate With Each Other

a. Clinical Collaboration Across Pathways

ICSs must collaborate on:

cancer
cardiovascular disease
urgent & emergency care
frailty
stroke
paediatrics
mental health
elective recovery

Clinical pathways must be regionally aligned because patient behaviour already is.

b. Workforce Collaboration

ICSs need:

regional staff banks
shared rotation programmes
cross-system training
joint recruitment campaigns
regional medical and nursing leadership networks

No ICS can fix workforce alone.

c. Financial Collaboration

ICSs must coordinate:

capital plans
control totals
productivity programmes
elective budgets
shared procurement
RWE investment programmes

Financial resilience is achieved at regional scale, not ICS scale.

d. Digital Collaboration

ICSs should share:

common data platforms
interoperable regional EHR infrastructure
shared AI-enabled analytics
digital care-coordination tools

Digital fragmentation is the enemy of integration.

How MedTech, Biotech, Digital Health, and Pharma Must Collaborate With ICSs

ICSs cannot meet their statutory duties without industry.
But the model of collaboration has fundamentally changed.

(1) MedTech Collaboration — Evidence, Integration, and System Value

MedTech companies must now:

work across multiple trusts and entire ICS regions
generate population-level outcomes data
demonstrate value in pathways, not products
align with ICS prevention and inequality strategies
support workforce efficiency and digital integration

ICSs expect MedTech to act as system partners — not device suppliers.

(2) Biotech Collaboration — Precision and Targeting

Biotech partners can support ICSs through:

genomic testing strategies
stratification of high-risk groups
precision oncology and infectious-disease diagnostics
biomarker-driven pathways
regional RWE programmes

This directly supports ICS population-health responsibilities.

(3) Digital Health Collaboration — The Infrastructure of Collaboration

Digital innovators must collaborate by providing:

interoperable platforms
shared analytics layers
remote monitoring across ICSs
AI-enabled risk-prediction models
population-health dashboards

Digital tools that only work in one trust or one PCN are now obsolete.

(4) Pharmaceutical Collaboration — Outcomes, Not Units

Pharma collaboration must include:

outcomes-based agreements
regional disease-management strategies
adherence programmes
multimorbidity management across primary and secondary care
real-world evidence that supports ICS pathways
co-developed prevention initiatives

ICSs expect pharma to become population health partners, not uniform product vendors.

The Collaboration Framework for 2026–2030

A successful health system in England now requires collaboration at four levels:

Regional Level

Strategic planning, workforce, digital, capital, and major clinical networks.

ICS Level

System-wide governance, finance, urgent care planning, elective strategy.

Place Level

Local delivery with councils, PCNs, and community organisations.

Industry Partnerships

Integrated innovation across all layers — evidence, digital, workforce, and pathways.

This is the operating system of integrated care in 2026.

Collaboration Is the ICS Model

ICSs were created to integrate care — but the scientific evidence shows the NHS is naturally structured around regional ecosystems, not administrative borders.
Financial pressures demand cooperation.
Workforce pressures require shared planning.
Digital transformation needs scale.
Population health requires multi-sector innovation.

By 2026, collaboration is not a feature of ICSs.
It is the entire model.

ICSs that collaborate across regions

with providers
with local authorities
with PCNs
with MedTech, biotech, digital health, and pharma

will deliver safer, more efficient, more equitable care.

Those that do not will fall behind.

Key References

Chikwira L., Charles A., Ewbank L., Walsh N., Murray R. Realising the Potential of Integrated Care Systems. The King’s Fund, July 2024. Available at: https://www.kingsfund.org.uk/insight-and-analysis/reports/integrated-care-systems-workforce The King’s Fund
Clarke J., Beaney T., Majeed A., Barahona M. Defining Integrated Care Systems Through Patient Data From Referral Networks in the English National Health Service: A Graph-Based Clustering Study. (2018/2019). Available at: https://www.researchgate.net/publication/351682622_Defining_Integrated_Care_Systems_Through_Patient_Data_From_Referral_Networks_in_the_English_National_Health_Service_A_Graph-Based_Clustering_Study ResearchGate
Naylor C. Progress so far and the challenges ahead: the development of Integrated Care Systems in the English NHS. International Journal of Integrated Care, 2025;25: 506. DOI:10.5334/ijic.ICIC24238. Available at: https://ijic.org/articles/10.5334/ijic.ICIC24238 International Journal of Integrated Care
“Commissioning [Integrated] Care in England: An Analysis Amid the Transition Toward ICSs.” Gongora-Salazar P., et al. PMC. 2022. Available at: https://www.ncbi.nlm.nih.gov/articles/PMC9541117/ PMC
Understanding Patient Data. Research into the use of data by Integrated Care Systems. Available at: https://understandingpatientdata.org.uk/ics-data-research Understanding Patient Data
Charles A., Ewbank L., Naylor C., Walsh N., Murray R. Developing place-based partnerships: The foundation of effective integrated care systems. The King’s Fund, April 2021. Available at: https://www.kingsfund.org.uk/insight-and-analysis/reports/place-based-partnerships-integrated-care-systems The King’s Fund
“Integrated care systems need to be different – but how?” Blog by The King’s Fund, March 2022. Available at: https://www.kingsfund.org.uk/insight-and-analysis/blogs/integrated-care-systems-need-different-but-how The King’s Fund
“Driving Better Health Outcomes Through Integrated Care Systems: The Role of District Councils.” The King’s Fund, July 2023. Available at: https://www.kingsfund.org.uk/insight-and-analysis/reports/driving-better-health-outcomes-integrated-care-systems-role-district-councils The King’s Fund
SCIE. Leadership in Integrated Care Systems (ICSs). Available at: https://www.scie.org.uk/integrated-care/leadership/systems/ scie.org.uk

Integrated Care Systems in 2026: How to collaborate.