An Integrated Care System does not arrive finished. The organisations that make one work spend years building relationships, shared data and trust before the system moves quickly on anything. That slow start is not a failure of the model. It is what large-scale collaboration actually costs before it pays off, and it has direct lessons for how any organisation plans training and implementation, not only within the NHS.

What the evidence actually shows

Integrated Care Systems bring NHS organisations, local authorities and other partners together to plan and co-ordinate care for local populations, rather than each organisation working alone. From 1 April 2026 there are 36 statutory integrated care boards in England, reduced from the 42 originally established, following a programme of mergers and boundary changes. Independent reviews of how they are progressing describe a consistent pattern: real gains in collaboration, workforce planning and shared purpose, arriving unevenly and more slowly than early expectations suggested.

The King's Fund's national review found that many systems are beginning to build a genuinely whole-system approach to workforce, with organisations working together more closely on workforce issues than before, and are starting to scale and spread what works rather than each site solving the same problem separately [1]. The same review is candid that this progress has come against some of the most difficult conditions the NHS has faced, and that it has not come easily or evenly across the country.

The Health Foundation's 2026 assessment found that the new systems took time to get up and running, with leaders having to work through complex governance, unclear responsibilities and continuing operational pressure [2]. It also warns that further structural change can disrupt the cross-sector collaboration that Integrated Care Systems were created to support. NHS Confederation's annual stocktake describes a similarly mixed picture: some systems are further ahead than others, and clear structures do not always translate into consistent implementation [3].

Nottingham and Nottinghamshire's own system illustrates why the starting point matters. The King's Fund's site profile of the system notes that it benefited from a history of collaboration and partnership working already in place before the ICS was formally established, which gave it strong local relationships and working examples of integrated care to build on, rather than starting from nothing [4]. The system built a shared Collaborative Planning and Commissioning Framework and ran a structured programme of "Learning Laboratories" to test how partners would work together in practice, an explicit, deliberate way of building the trust and shared method that make later, faster work possible [5].

Why maturity changes what is possible

The pattern across these reviews is consistent, whatever the local detail: the visible slowness of early collaboration is not wasted time. It is where the relationships, the shared understanding of local need, and the working habits get built that make faster, larger initiatives possible later. A system with no history of joint working has to build all of that before it can move on anything substantial. A system that has already done that work, even in one area, can often extend it into new areas much faster, because the harder, slower groundwork is already in place.

That has a direct parallel in how organisations approach workforce training and implementation, independent of the NHS entirely. A single course does not create lasting capability. What creates it is the same kind of groundwork an ICS needs: agreed standards, people who know their role, a way of testing new practice locally before it scales, and time built in for that practice to become reliable. Organisations that skip the groundwork and expect a training day alone to produce system-wide change tend to see exactly what the ICS literature describes: real short-term activity, but slow, uneven translation into lasting practice.

What this means for planning training and implementation

• Expect the early phase to look slow, and plan for it rather than around it. Reviews of ICS progress make the same point about system integration that experienced trainers make about skills training: the visible pace of change in the first period is not a reliable guide to what becomes possible once foundations are in place.
• Invest deliberately in the groundwork, not just the delivery. Nottingham and Nottinghamshire's Learning Laboratories approach, and the wider NHS workforce literature's emphasis on a "whole-system" view, both point to the same discipline: agree how partners or teams will work together and test it in a low-risk way before scaling it.
• Build on what already exists locally, rather than starting from zero. Systems and services with a working history of collaboration move faster on new initiatives than those without one. The practical implication for training and implementation planning is to map what local capability and relationships already exist before designing a new programme, rather than assuming everyone is starting from the same point.
• Treat spread and scale as deliberate work. The King's Fund identifies scaling and spreading success as one of six ways systems add value, underpinned by less visible work to strengthen relationships, mindsets and behaviours [1]. Training delivery alone does not make that spread automatic.

None of this is a claim that VeinTrain's own training programmes have been formally evaluated against the ICS literature, and none of the figures above are VeinTrain's. They are drawn directly from the national reviews listed in the References below, and are presented here because the pattern they describe, groundwork before pace, is directly useful to anyone planning implementation or training at scale, in or out of the NHS.

How VeinTrain supports the practical side of this

VeinTrain trains clinicians to deliver IV cannulation, venepuncture and phlebotomy safely, and to teach those skills to others locally through Train the Trainer. Its HALO organisational deployment model exists for the same reason the evidence above points to: building the local groundwork, a named trainer, a supervised first cohort, an agreed standard, before an organisation tries to scale delivery across multiple sites or teams. VeinTrain training supports the structured route to competence; final clinical competency sign-off always remains with the employer, supervisor or clinical organisation, within local policy, supervision and scope of practice.

If your organisation is working through what an integration, merger or system-wide collaboration means for how you train and support staff locally, a conversation is the right next step before a course booking.

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Related reading

• What is HALO
• What a HALO roll-out looks like

References

1. The King's Fund. Realising the potential of integrated care systems: workforce. kingsfund.org.uk (UK, INDEPENDENT REVIEW)
2. The Health Foundation. Integrated care systems in England: where next? March 2026. health.org.uk (UK, INDEPENDENT RESEARCH)
3. NHS Confederation. The state of integrated care systems 2023/24 (2024). Now hosted by The NHS Alliance: thenhsalliance.org (UK, SECTOR BODY REPORT)
4. The King's Fund. A year of integrated care systems: Nottingham and Nottinghamshire. kingsfund.org.uk (UK, INDEPENDENT CASE STUDY)
5. Institute of Public Care, Oxford Brookes University. Nottingham and Nottinghamshire Integrated Care System: supporting collaborative commissioning, a learning laboratory approach. ipc.brookes.ac.uk (UK, UNIVERSITY CASE STUDY)

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