59 Suffolk and North East Essex ICS | ‘Our Journey Together’ 7.5 A national policy perspective Progress despite national policy, not because of it What partners across Suffolk and North East Essex have achieved over the past year is not to be ignored. Let’s not beat around the bush: the NHS is an ecosystem dictated largely by a centuries-old philosophy about the management of public services. These are focused on command-and-control relationships and vertical accountability up to Whitehall, and a political dynamic that, because of political cycles and the demands of modern media, prioritises immediate recovery over long-term reform. I’ve heard experts say, many times, that it is the most centralised health system in the world. Compound this with the need for ministers to be seen to be the agents of change, to claim that victory was the result of an action taken in Whitehall – realising a true integrated care system was always going to be a seismic ask. Systems working is in many respects the antithesis of how our government works. At its core, systems working results from local need, not national priorities. Accountability flows outward, towards the public and partners, not upwards into government. It is the product of relationships developed over time as a coalition of equals, founded on a bedrock of trust and mutual dependency. It pursues the issues important to real people in a local place. It is, to borrow Susannah Howard’s metaphor, much closer to the ecosystem of a coral reef than an industrial production line whereby a small action at one end causes a chain reaction leading to the right outcome at the other. To put it kindly, this is hard to legislate for. I worked with the government and NHS England through the development of the 2022 Health and Social Care Act, which was a commendable attempt at legislating against the tide. They encouraged partnership working through the establishment of integrated care partnerships (ICPs), and, through guidance, gave ICSs four purposes which included prioritising the determinants of health that sit outside the influence of the NHS – housing, employment, transport, education and so on. Policymakers I speak to recognise the tension they faced: balancing the freedom for systems to flourish, providing the guardrails so that no part of the country falls by the wayside or fails its people, and providing politicians with a point of accountability – someone to speak to when things go wrong. At the same time as implementing the Act in the years since, the age-old tension between recovery and reform continued. Pressure on services, and therefore on NHS finances, mounted. The same is true of wider public services too. Last year, in 2025, the pressure on policymakers to act, once again, reached a boiling point. The old maxim that the only constant is change could not be truer in the NHS. Reading this publication validates many of the things we already know about how good systems working really happens, but the ability to realise those things when the constant ebbing and flowing of tidal pressure on policymakers, in turn, results in pressure on local system leaders to the degree that it has, only highlights to me just how astounding the progress made by Suffolk and North East Essex really is. While no system gets everything right all the time, there are so many great examples here of local people making real change happen. If there is a lesson for me about the progress you have all made, it’s that a focus on what matters to people locally, embodied by a clear mission and commitment to true partnership working, can result in meaningful change despite national policy not because of it. I’ve no doubt that that will be taken forward in new guises and through new opportunities in the future. Ian Perrin Assistant Director, Policy, ICS Network NHS Confederation
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