This page provides a summary of national proposals to develop integrated care systems (ICS) from April 2022; and local context for Kent and Medway. All proposals are subject to legislation going through Parliament during 2021.
The proposed ICS structures include two core elements.
- The ICS partnership as the collective of all local partners including NHS organisations, local authorities and other partners.
- The ICS NHS Body as the statutory NHS organisation that will take on the responsibilities of Clinical Commissioning Groups and any further responsibilities delegated by NHS England and NHS Improvement.
Information in the boxes below is taken from the NHS England ICS design framework published in June 2021.
Each ICS partnership will be responsible for agreeing an integrated care strategy for improving health care, social care and public health across their whole population, using the best insights from data available, built bottom-up up from local assessments of needs and assets identified at place level and focusing on reducing inequalities and addressing the consequences of the pandemic for communities.
The ICS partnership is expected to be established locally and jointly by the relevant local authorities and the ICS NHS body, evolving from existing arrangements and with mutual agreement on its terms of reference, membership, ways of operating and administration.
Local authorities that provide social care services in the ICS area and NHS organisations must be included. Beyond this, members may be from health and wellbeing boards, other statutory organisations, VCSE sector partners, social care providers and organisations with a relevant wider interest such as employers, housing and education providers. The membership may change as the priorities of the partnership evolve.
Subject to legislation being passed, Clinical Commissioning Groups will be replaced by new NHS statutory organisations from April 2022. These are currently called the "NHS ICS body". In Kent and Medway there would be one organisation covering the same boundaries as the current CCG.
Responsibilities of the ICS NHS body
Developing a plan to meet the health needs of the population within their area, having regard to the partnership’s strategy and the local health and wellbeing strategy, ensuring NHS services and performance are restored following the pandemic and that constitutional standards (including statutory duties for quality) and Long Term Plan commitments are met.
- Allocating resources to deliver the plan by deciding how its national allocation will be spent across the system.
- Establishing joint working arrangements with partners that embed collaboration as the basis for delivery of joint priorities. The ICS NHS body may choose to commission jointly with local authorities across the whole system; at place where that is the relevant local authority footprint.
- Establishing governance arrangements to support collective accountability between partner organisations for whole-system delivery and performance, underpinned by the statutory and contractual accountabilities of individual organisations, to ensure the plan is implemented effectively within a ‘system financial envelope’ set by NHS England and NHS Improvement (NHSEI).
- Arranging for the provision of health services in line with the allocated resources across the ICS footprint through a range of collaborative leadership activities, including: putting contracts and agreements in place to secure delivery of its plan by providers; convening and supporting providers to lead major service transformation programmes; and putting in place personalised care.
- Leading system implementation of the People Plan by aligning partners across each ICS to develop and support the ‘one workforce’.
- Leading system-wide action on digital and data to drive system working and improved outcomes.
- Use joined-up data and digital capabilities to understand local priorities, track delivery of plans, monitor and address variation and drive continuous improvement in performance and outcomes.
- Working alongside councils to invest in local community organisations and infrastructure and, through joint working between health, social care and other partners including police, education, housing, safeguarding partnerships, employment and welfare services, ensuring that the NHS plays a full part in social and economic development and environmental sustainability.
- Driving joint work on estates, procurement, supply chain and commercial strategies to maximise value for money across the system and support these wider goals of development and sustainability.
- Leading the preparation and execution of emergency response.
All still relevant clinical commissioning group (CCG) functions and duties will transfer to an ICS NHS body when they are established, along with all CCG assets and liabilities, including their commissioning responsibilities and contracts.
The Board of the ICS NHS Body
The statutory minimum membership of the board of each ICS NHS body will be confirmed in legislation. In most cases they will include the following roles:
- Independent Chair plus a minimum of two other independent non-executive directors.
- Chief Executive
- Director of Finance
- Director of Nursing
- Medical Director
- at least one member drawn from NHS trusts and foundation trusts who provide services within the ICS’s area
- at least one member drawn from general practice within the area of the ICS NHS body
- at least one member drawn from the local authority, or authorities, with statutory social care responsibility whose area falls wholly or partly within the area of the ICS NHS body.
Beyond these positions, the ICS NHS body may establish other specific executive or non-executive members to ensure that the board is well governed and can meet its statutory duties and objectives.
ICSs will need to build a range of engagement approaches into their activities at every level and to prioritise engaging with groups affected by inequalities. It is expected this will be supported by a legal duty for ICS NHS bodies to make arrangements to involve patients, unpaid carers and the public in planning and commissioning arrangements.
Working with a range of partners such as Healthwatch, the VCSE sector and experts by experience, the ICS NHS body should assess and where necessary strengthen public, patients’ and carers’ voice at place and system levels. Arrangements in a system or place should not just provide commentary on services, but should be a source of genuine co-production and a key tool for supporting accountability and transparency of the system.
NHSEI has set out seven principles for how ICSs should work with people and communities on page 36 of the June 2021 ICS design framework. These principles should be used as a basis for developing a system-wide strategy for engaging with people and communities. As part of this, the body should work with its partners across the ICS to develop arrangements for:
- Ensuring the ICS partnership, and place-based partnerships have representation from local people and communities in priority setting and decision-making forums; and
- Gathering intelligence about the experience and aspirations of people who use care and support, using these insights to inform decision-making and quality governance.
In Kent and Medway we will be drafting and engagement framework for the ICS during the summer of 2021.