NHS England have launched a consultation on developing a form of Integrated Care Systems (ICS) to underpin their push to create a statutory decision making body for ICS across England.

This is an exciting opportunity for local government to present a strong voice in the integration agenda.

The immediate priority is responses to the proposals on the UICS structure, which NHS England is calling for by 8 January. The consultation paper includes a description of the two options being presented together with four questions on which they are seeking responses.

What are the options?

The consultation paper set outs two options for statutory reform:

• A statutory joint committee model where representatives of the CCG, local authority, primary care and at least NHS local providers to take decisions which can bind the parties. It is also proposed that there would be a system accountable officer, chosen from the AOs or CEOs of the board’s mandatory members. The ICS board would be responsible for a system plan, and all members would be bound to comply with it. Given the role of the system plan, it would appear that the high level commissioning functions would be ICS business, which it is acknowledged might leave the CCG as a parallel body with few other functions.
• A new statutory NHS body which would replace CCGs and carry out the ICS functions. This is more radical, but is preferred as a more long-term solution to the issues. GP membership and the current CCG governing body would be replaced by an ICS board with members as for option 1 plus a CEO a chair and a Finance director. This would take on the high level commissioning functions of CCGs, and the avoidance of the current conflict of interest in primary care is noted. The paper does not address the newly created conflicts of the ICS board including NHS providers who are equally conflicted.

What are the questions?

The consultation paper asks the following four questions:

Q 1. Do you agree that giving ICSs a statutory footing from 2022, alongside other legislative proposals, provides the right foundation for the NHS over the next decade?

Q 2. Do you agree that option 2 offers a model that provides greater incentive for collaboration alongside clarity of accountability across systems, to Parliament and most importantly, to patients?

Q 3. Do you agree that, other than mandatory participation of NHS bodies and Local Authorities, membership should be sufficiently permissive to allow systems to shape their own governance arrangements to best suit their populations needs?

Q4. Do you agree, subject to appropriate safeguards and where appropriate, that services currently commissioned by NHSE should be either transferred or delegated to ICS bodies?

What are the implications for Local Government?

Discourse on potential changes to the statutory framework governing NHS and LA collaboration requires local government input to ensure that any future initiatives are effective in facilitating whole system change in health and social care. 

It is encouraging to review proposal for fundamental change in the statutory framework to support greater collaboration in the health and social care economy and accountability framework. Such change, however, needs to be driven by adequate engagement and involvement of all stakeholders.

• Preferred option?

The paper does make clear NHSE’s preferred approach, however, what works well for whole system change? At this stage, the first option would appear to provide a better platform for local authorities having a meaningful seat at the partnership table, however, there are some unanswered questions over the extent to which option 1 as currently framed could be sufficiently supported by the current systems infrastructure and contracting framework.

Whilst option 2 would appear to be a clearer model and avoids what would otherwise be a messy et of accountability lines and whilst the establishment of a new statutory framework would in theory be a stepping stone to between integrated working within the NHS, the extent to which this would enable local government to be part of the integrated care system is questionable in its current form. Further enabling and supporting framework would continue to be required.

• Interface with Local Government commissioning

In the review process for both options being presented, detailed consideration of the role of local authorities as commissioners and practicalities over the governance interface between any new entities is required. Currently neither options seems to grapple with the position of local authorities as commissioners, and it is unclear how the financial allocations will work across health and social care boundaries.

Local authorities have existing relationships across the NHS and any whole system change requires detailed analysis of the implication for any reform for those current partnership arrangements. To date, there are a number of lessons to learn from NHS and LA collaboration in relation to organisation cultural, alignment of accounting and financial processes, we well the differing governance and accountability arrangements between the two sectors.

Review of both options needs a more detailed analysis of the role of LA commissioners and also from a financial perspective, the practical consideration of how the financial allocations will work across health and social care boundaries.

• Wider public health agenda

The success of any such reform requires a cultural change in approach to care provision from within and such change needs to recognise the challenges being faced by all stakeholders in service commissioners and provision in the wider health and wellbeing agenda.  

Whilst these problems reflect a detailed review of the NHS commissioning landscape and indeed significant changes to the reforms previously brought in by the Health and Social Care Act 2012, however, consideration must now be given to the impact on local authority commissioning and provision. Where would these reforms leave health and wellbeing, and its interface with the local authority public health function? The Covid-19 pandemic has heightened the need to address public in equalities and this is an opportunity to be missed to highlight the critical role of the public health agenda in health and social care.

We recognise you will have your own views on these proposals, but we would recommend letting NHS England know.

For more information on ICS developments please contact: Kirtpal Kaur Aujla and Judith Barnes.