Source · Select Committees · Public Accounts Committee
Recommendation 20
20
Accepted
NHSE reorganisation and staffing cuts risk its capacity to monitor and hold ICBs accountable.
Conclusion
In line with the approach for all health services, the 2023–24 planning guidance for NHS trusts and ICBs reduced the number of nationally mandated objectives to six for mental health.38 Although the national programme led by NHSE has maintained a consistent focus to date, NHSE and other national arm’s length bodies are going through a period of significant change, with mergers and reductions of 30–40% in central staffing. This reorganisation raises many potential risks to NHSE’s capacity and ability to monitor 31 C&AG’s Report, paras 3, 11 32 Qq 104–105, 121–125, 152–153, 165 33 Q 7; House of Commons Committee of Public Accounts report, Introducing integrated care systems, Thirty-Fifth report of session 2012–23; PMS0015, page 3; PMS0018, page 2 34 Qq 168–171; C&AG’s Report , paras 11, 2.17 35 Qq 152–157 36 Q 7 37 Qq 79, 119, 163–166 38 C&AG’s Report, para 1.12 14 Progress in improving NHS mental health services and hold ICBs to account.39 We have also noted recently that support and accountability arrangements for ICSs are still underdeveloped.40 We asked about inconsistencies in local practice which are of concern, for example, the patchy implementation of clinical guidance for people with eating disorders; but it was not clear to us from the answer how NHSE would ensure that ICBs keep on top of these issues.41 Defining the long-term goal of ‘parity of esteem’
Government Response Summary
The government agrees with the Committee's observations, highlighting existing oversight through the NHS Oversight Framework, ICB reporting requirements on mental health expenditure, and statutory mandates for mental health expertise on ICB boards to ensure accountability and address local inconsistencies.
Government Response
Accepted
HM Government
Accepted
3.1 The government agrees with the Committee’s recommendation Target implementation date: Summer 2024 3.2 The NHS Oversight Framework outlines NHS England’s approach to overseeing Integrated Care Boards (ICBs) and trusts, utilising 63 metrics, 6 of which relate to mental health. NHS England will continue to undertake delivery assurance within the new model outlined in the NHS Operating Framework, which is complemented by central data repositories that provide an overview of performance at a national, regional, ICB and sub-ICB level. NHS England segments ICBs and NHS trusts on a scale of 1 to 4 and provides mandated support for the most challenged providers and systems. NHS England also conducts annual performance evaluation of ICBs. 3.3 From 2023-24, all ICBs are also required to include a statement of the amount and proportion of expenditure incurred by the ICB in relation to mental health in their annual report, increasing ICBs’ public accountability for their decisions on mental health investment. NHS England will assure ICB spending plans and actual spend. To ensure mental health is sufficiently prioritised, the Health and Care Act 2022 requires that ICBs must have a member who has mental health expertise on the Board. 3.4 NHS England is working within the new operating model to ensure systems are empowered to self-assure spending and delivery, but significant risks and issues will continue to be escalated to support a strategic response. 3.5 NHS England and the department will continue to monitor this approach to ensure that appropriate support is being offered to ICBs.