Recommendation 12

The oversight of ICSs largely focuses on the NHS elements, and we are concerned the wider system is being overlooked. NHS England has established a very detailed performance regime to monitor Integrated Care Boards’ contributions to NHS objectives. NHS England confirmed to us that it retains its power of intervention, and that if a provider or system was under performing it would expect to pick that up very quickly and provide appropriate support.35 Arrangements for evaluating how the overall system is functioning, including ensuring that local partners are working well together, are less clear.36 We asked the Department what happens in the event of a disagreement between the NHS and local partners, and it told us that while existing intervention powers across both health and social care remain unchanged, the Care Quality Commission will now have a new role to look at the effectiveness of partnership working locally.37 However, as the NAO’s report points out, the Care Quality Commission’s role will focus on monitoring, assessing and reporting, and it will not have any direct enforcement powers over ICSs.38 The Department has policy responsibility for both health and social care, and 31 C&AG’s Report, para 2.34, ICS0012, ICS0039 32 Q 53, ICS0039 33 Qq 53–54, Committee of Public Accounts, Integrating health and social care, Sixtieth report of Session 2016–17, HC 959, 27 April 2017, and letter dated 18 November 2022 from Chris Wormald at the Department of Health & Social Care to the Committee 34 Qq 108, 133, 139, 142, 35 Q 28 36 C&AG’s Report, para 13, ICS0011 37 Qq 112, 147, C&AG’s Report, para 1.32 38 C&AG’s Report, para 1.32 Introducing Integrated Care Systems 13 when pressed on what it would do in the event of the Care Quality Commission flagging an issue within an ICS that cut across both sectors, it was unable to describe the steps it would take to support ICSs to get back on track.39