Source · Select Committees · Health and Social Care Committee
Seventh Report - Integrated Care Systems: autonomy and accountability
Health and Social Care Committee
HC 587
Published 30 March 2023
Recommendations
5
Accepted
Para 28
Explain DHSC mechanisms ensuring progress on local ICS priorities and their national balance.
Recommendation
DHSC should explain the mechanisms that will ensure that progress is made against local priorities. It should set out how this compares to mechanisms used to measure progress against national priorities, alongside an assessment of whether this balance will support …
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Government Response Summary
The government explained its current framework for balancing national and local priorities through the Health and Care Act 2022 and NHS England guidance, and committed to publishing a shared outcomes toolkit to support the development of local outcomes.
Department of Health and Social Care
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6
Accepted
Para 29
Publish proposed shared outcomes framework and ICS implementation details urgently.
Recommendation
DHSC should publish, as soon as possible, the proposed shared outcomes framework and more information about how and when ICSs should expect it to be implemented.
Government Response Summary
The government outlined the existing framework for ICSs, including the mandate to NHS England and planning guidance, which it believes already provides the right balance and processes for delivering on ICS purposes.
Department of Health and Social Care
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11
Accepted
Para 42
ICS success depends on long-term decision-making and assured future funding.
Recommendation
The four key purposes of ICSs are all dependent on taking a long-term approach. In order to fulfil them, ICSs need to be supported to make long-term decisions and have as much certainty as they can about upcoming funding.
Government Response Summary
The government commits to supporting ICSs by improving funding certainty, pledging to align allocation publications across various sectors and provide as much notice as feasible for future years. They highlight indicative allocations for the Public Health Grant 2024-25 as an example of this commitment.
Department of Health and Social Care
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17
Accepted
Para 54
Empowering MPs to directly hold local ICSs accountable requires transparent performance data.
Recommendation
Members of Parliament should be supported to directly hold their local ICSs to account for the service they provide to constituents, without having to rely on an assessment provided by local health and care leaders. We believe this is an …
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Government Response Summary
The government supports increased transparency for MPs to hold ICSs to account, committing to publishing more performance data, including practice-level appointment data, A&E wait times, and new discharge metrics. They are also working with Oflog to include discharge metrics in local authority performance assessments.
Department of Health and Social Care
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21
Accepted
Para 64
Action needed from DHSC to resolve issues of poor partnership working in ICSs
Recommendation
DHSC, working with ICSs, should clearly set out what action could be taken, be that by the CQC, NHS England or others, to resolve issues of poor partnership working, in particular with adult social care.
Government Response Summary
The government states that the recommendation aligns with NHS England's existing oversight framework, which outlines how NHS England, in collaboration with ICBs, addresses issues of poor partnership working, including direct intervention in exceptional circumstances.
Department of Health and Social Care
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24
Accepted
Para 73
Review gathered ICB membership data to assess representation and policy effectiveness
Recommendation
Once the data is gathered, DHSC should review it with a view to understanding whether the policy of keeping mandated representation to a minimum is producing the intended results and whether any specialties are especially under-represented. They should report the …
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Government Response Summary
The government stated that NHS England will conduct annual performance reviews of ICBs and CQC will assess ICSs under a single assessment framework in alignment with NHS England, focusing on system-wide evaluation rather than the specific review of professional representation data.
Department of Health and Social Care
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Conclusions (6)
1
Conclusion
Accepted
Para 17
It is clear that Integrated Care Systems offer a new way of working across health and social care. They encourage collaboration with a range of partners and a focus on what matters to their local populations. This fundamental premise needs to be balanced within a national service, funded by taxpayers …
Government Response Summary
The government acknowledged the importance of outcomes-based targets and stated its existing approach includes the Levelling Up health mission and a reduction to 31 national NHS objectives for 2023-24, balancing national and local target setting.
2
Conclusion
Accepted
Para 18
However, if ICSs are to realise the ambitions that have been set for them, and move beyond collaboration towards true integration, it is vital that DHSC and NHS England do not dictate how ICSs should deliver those outcomes. NHS England will also need to be conscious of its organisational culture …
Government Response Summary
The government acknowledged the importance of outcomes-based targets and stated its approach includes both national targets, like the Levelling Up health mission, and allowing local systems to set their own targets, aiming for a small core set of national priorities.
4
Conclusion
Accepted
Para 27
We welcome the clear references to local priorities within NHS England guidance for ICSs and DHSC’s proposed shared outcomes framework. We hope that, in the years to come, this focus on local priorities will be maintained. However, we share the NAO’s concern about the tension between local needs-based strategies and …
Government Response Summary
The government explained its existing framework for balancing national and local priorities through the Health and Care Act 2022 and recent planning guidance, and committed to publishing a shared outcomes toolkit to support the development of local outcomes.
7
Conclusion
Accepted
Para 36
Unfortunately, there is a clear risk that short-term, acute pressures will dominate ICS capacity, resources and leadership headspace, limiting the true flexibility of ICSs. Active effort from DHSC and NHS England is needed to ensure ICSs retain the space they need to focus on matters like public health and prevention. …
Government Response Summary
The government committed to exploring how to equip system leaders with the right skills, accepting the value of a national leadership program, and has formed a senior advisory group to plan a three-year roadmap for leadership development.
9
Conclusion
Accepted
Para 38
Improving outcomes in population health and healthcare is one of the four core purposes of ICSs. Despite this, there is no mandated representation for public health professionals on Integrated Care Boards. Without that voice of expertise driving the public health agenda on ICBs, we are sceptical that ICSs will succeed …
Government Response Summary
The government stated that NHS England’s existing oversight framework already aligns with the recommendation's principle, outlining how NHS England oversees ICBs and providers.
13
Conclusion
Accepted
Para 47
System leadership is different to organisational leadership and ICS leaders, as well as leaders at other levels, need support to develop skills to make the most of the opportunities and to ensure ICSs do not become too NHS centric. Systems need leaders that will work collaboratively and not be tied …
Government Response Summary
The government stated that NHS England’s new operating framework already reflects system-based approaches and stronger partnership working, aiming to co-create strategy with wider partners.