Integrated Care Systems Respiratory Transformation: 7 Mistakes You're Making (and How to Fix Them)
Integrated Care Systems were designed to break down barriers and deliver better outcomes for patients with long-term conditions. In respiratory care, where timely diagnosis and coordinated pathways can mean the difference between managing symptoms and preventable hospital admission, this promise matters.
But three years into the ICS framework, the reality on the ground tells a different story. Most integrated respiratory programmes aren't failing because of a lack of ambition. They're failing because of predictable, fixable mistakes that keep repeating across different systems.
This isn't about blame. It's about clarity. If you're leading respiratory transformation in an ICS, or working with one as a Life Sciences partner, these are the seven patterns you need to recognise: and correct.
Mistake 1: Treating Integrated Care as a Cost Containment Exercise
Many integrated respiratory care programmes are justified internally through business cases built on cost reduction. The logic appears sound: better coordination should reduce emergency admissions, which should lower spend.
In practice, this framing creates failure from the start. Evidence shows that integrated care models are fundamentally designed to improve care quality, not cut costs[1]. When respiratory pathways are improved, previously unmet need in the community becomes visible. Demand increases. Without additional capacity in primary and community care, this doesn't prevent hospitalisations: it creates bottlenecks.
The fix: Reframe integrated respiratory care as a quality and equity programme that requires investment before it delivers efficiency. Be honest about the timeline. Build the business case around outcomes that matter to patients: earlier diagnosis, better symptom control, reduced variability in care.
Mistake 2: Mistaking Structural Change for Clinical Integration
Reorganising accountability structures, renaming directorates and redrawing boundaries feels like progress. It isn't.
Recent reviews of UK Integrated Care Systems found that complex regulatory and systemic requirements are slowing the emergence of practical integrated care solutions[1]. While leadership debates governance frameworks, the clinical teams who need to coordinate care for individual patients often lack the basic tools, relationships and time to do so.
The fix: Optimise care at the service and clinical level. Focus on how multidisciplinary teams coordinate care in partnership with patients, not how trusts report to ICBs. Support respiratory nurses, GPs, and pharmacists to work together in practice, not just on an org chart.
Mistake 3: Building Programmes That Sit Outside Core Services
Integrated respiratory care initiatives often begin as pilot projects: time-limited, funded through transformation money, staffed by enthusiastic champions. Early results look promising. Then funding ends. The champions move on. The programme folds.
High discontinuation rates occur when programmes operate outside established core service delivery models with non-recurrent funding[1]. What worked in a twelve-month pilot cannot scale if it relies on goodwill and temporary resource.
The fix: Embed integrated respiratory care within existing service structures from the start. Secure recurrent funding. Make it part of standard operating procedure, not a special project. If you cannot fund it beyond year one, do not launch it.
Mistake 4: Failing to Place People and Communities at the Centre
Integrated care models must prioritise patients, not systems[5]. Yet many respiratory transformation programmes are designed around operational convenience: clinic locations that suit providers, referral criteria that manage demand, outcome measures that reflect system performance rather than patient experience.
This matters because spirometry measurements and clinical severity classifications poorly reflect individual disease burden and quality of life in respiratory conditions[4]. A patient with "mild" COPD by lung function may experience severe functional limitation. A person with well-controlled asthma on paper may be one trigger away from crisis because they cannot afford to heat their home adequately.
The fix: Co-design pathways with patients who have lived experience of asthma, COPD and other respiratory conditions. Measure what matters to them: confidence in self-management, access to timely support, reduction in anxiety about breathlessness. Use patient-reported outcomes, not just clinical metrics.
Mistake 5: Ignoring Diagnostic Capacity Gaps
Over half of England's Integrated Care Systems: 16 out of 27: lack sufficient spirometry testing capacity to meet demand for COPD diagnosis[3]. Large gaps in data collection make it impossible to gauge the true scale of shortages or the resources needed to address them[3].
An estimated £40 million is required to address diagnostic backlogs across respiratory services[3]. Without this investment, integrated care pathways cannot function. Patients wait months for tests that should happen within weeks. GPs manage empirically. Hospital admissions follow.
The fix: Conduct an honest capacity audit. Identify diagnostic gaps in spirometry, FeNO testing and respiratory physiology. Make the investment case clearly, linking diagnostic delay to avoidable harm and cost. Consider community diagnostic hubs and mobile testing where fixed infrastructure is inadequate.
Mistake 6: Not Building the Right Team Relationships
The British Thoracic Society's evidence-based model for successful integrated respiratory healthcare starts with relationships[5]. Not governance structures. Not IT systems. Relationships between providers.
In practice, this means respiratory consultants who know their community pharmacists by name. Practice nurses who can call a respiratory specialist directly when a patient's symptoms change. Physiotherapists and occupational therapists who understand what social prescribers offer.
The fix: Invest time in relationship-building before launching new pathways. Create opportunities for multidisciplinary learning and case discussion. Use shared patient records where possible, but recognise that trust between professionals enables integration even when systems remain imperfect.
Mistake 7: Treating Integrated Care as an NHS-Only Project
Life Sciences organisations often sit outside ICS transformation conversations, positioned as suppliers rather than partners. This is a missed opportunity on both sides.
Industry holds expertise in patient identification, pathway optimisation and outcome measurement that ICSs need. Pharmaceutical and diagnostics companies are investing in health inequalities and real-world evidence because the NHS Respiratory Strategy 2026 makes this commercially necessary. When this expertise is excluded from planning, integrated care models remain under-informed.
The fix: Create structured, compliant opportunities for Life Sciences input into pathway design. Use forums like The Respiratory Network's Round Table events to bring NHS leaders, patients and industry together for strategic dialogue. Ensure commercial relationships are transparent and governed, not avoided.
What Success Looks Like
Successful integrated respiratory care doesn't announce itself with a launch event. It shows up quietly in the data: earlier diagnoses, fewer emergency admissions, reduced variation in care quality across postcodes.
It shows up in what patients and clinicians describe: confidence that breathlessness will be taken seriously, access to support when symptoms worsen, a sense that the system is working together rather than in silos.
The British Thoracic Society's model for integrated respiratory healthcare emphasises five components: relationships, sustainable funding, clear goals, the right team, and active pathway delivery[5]. These aren't aspirational. They're practical prerequisites.
Moving Forward
If you recognise your ICS in one or more of these mistakes, that's useful information. Integrated respiratory care transformation is difficult. The system is under pressure. Resources are constrained. Expectations are high.
But the mistakes outlined here are fixable. They require honesty about timelines and costs. They require courage to prioritise relationships over structures. They require humility to learn from patients and partners, including those from Life Sciences.
The Respiratory Network exists to support these conversations. Our April 29th Round Table at The King's Fund brings together NHS respiratory leads, ICS decision-makers, patients with lived experience, and Life Sciences professionals to address these exact challenges in a compliant, strategic setting.
If you're working on respiratory transformation and want to connect with others who understand the complexity, join our network. No sales pitches. No simplistic solutions. Just practical insight from people doing the work.
References:
[1] Multiple research sources on integrated care implementation challenges (2024-2025)
[3] NHS England Spirometry Capacity Analysis (2024)
[4] British Thoracic Society Guidelines on Patient-Centred Respiratory Care (2023)
[5] British Thoracic Society Model for Integrated Respiratory Healthcare (2024)
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7 mistakes killing integrated respiratory care in ICSs: and how to fix them.
After reviewing transformation programmes across England, clear patterns emerge:
❌ Treating integration as cost-cutting
❌ Reorganising structures instead of clinical teams
❌ Running pilots that can't scale
❌ Ignoring diagnostic capacity gaps (16 of 27 ICSs lack sufficient spirometry)
❌ Designing systems without patients
The fix isn't more governance. It's practical: fund diagnostics, build team relationships, co-design with patients, include Life Sciences expertise appropriately.
New blog from The Respiratory Network breaks down what's not working: and what is.
Read: [link]
#NHSRespiratoryStrategy #IntegratedCareSystems #HealthInequalities #LifeSciencesPartnership
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16 of 27 English ICSs don't have enough spirometry capacity to diagnose COPD.
You can't integrate respiratory care if you can't diagnose respiratory disease.
New analysis from @RespNetwork: [link]
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Integrated care fails when it's treated as a cost-cutting exercise.
It's designed to improve quality, which often increases demand before it reduces admissions.
Honest blog on the 7 mistakes ICSs keep making in respiratory transformation: [link]
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"Build relationships between providers" is the first step in the BTS model for integrated respiratory care.
Not IT systems. Not governance. Relationships.
Our latest: [link] #NHS #IntegratedCare
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Most integrated respiratory care programmes aren't failing because of bad intentions. They're failing because of predictable, fixable mistakes.
Our latest blog breaks down 7 patterns we see across ICSs: and the practical fixes that work.
From diagnostic backlogs to team relationships to patient co-design, this is what success actually looks like on the ground.
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