Integrated Care Systems: autonomy and accountability

Health and Social Care Committee Closed Inquiry
Opened: 6 Jul 2022 Closed: 15 Aug 2023 Parliament page
The Health and Social Care Committee has launched a new inquiry to consider how Integrated Care Systems will deliver joined up health and care services to meet the needs of local populations. Forty-two new ICSs were established with a statutory footing across England on 1 July. Integrated Care Boards, one … Read more
10 Recommendations
20 Conclusions
1 Report
4 Oral sessions
1 Letter
4 Events
Activity timeline 11 events
14 Jun
2023
Report published
6 Jun
2023
Correspondence
30 Mar
2023
Report published
7 Feb
2023
Oral evidence
7 Feb
2023
Formal meeting (oral evidence session) · Room 16, Palace of Westminster
17 Jan
2023
Oral evidence
17 Jan
2023
Formal meeting (oral evidence session) · The Grimond Room, Portcullis House
6 Dec
2022
Oral evidence
6 Dec
2022
Formal meeting (oral evidence session) · The Thatcher Room, Portcullis House
8 Nov
2022
Oral evidence
8 Nov
2022
Formal meeting (oral evidence session) · Room 16, Palace of Westminster
Oral evidence sessions 4 sessions
7 Feb 2023
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Helen Whatley MP · Department of Health and Social Care Mark Cubbon · NHS England Matthew Style · Department of Health and Social Care
17 Jan 2023
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Kate Terroni · Care Quality Commission Louise Ansari · HealthWatch Nicholas Timmins · Institute for Government Sarah Walter · NHS Confederation Zina Etheridge · North East London ICS
6 Dec 2022
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Andrew Lane · National Pharmacy Association Dr David Wrigley · British Medical Association GP Committee Dr Linda Patterson · Bradford District Care NHS Foundation Trust Dr Trudi Seneviratne OBE · Royal College of Psychiatrists Miriam Deakin · NHS Providers Professor Jim McManus · Hertfordshire County Council Professor Vic Rayner OBE · National Care Forum Rob Darracott · P3 Pharmacy Sarah McClinton · Association of Directors of Adult Social Services
8 Nov 2022
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Chris Hopson · NHS England Councillor David Fothergill · Local Government Association Patricia Miller · NHS Dorset Professor Sir Chris Ham · NHS Assembly Rob Webster · West Yorkshire Health and Care Partnership Rt Hon Patricia Hewitt · NHS Norfolk & Waveney Integrated Care Board Sir David Nicholson · Sandwell and Birmingham NHS Trust and Dudley Group NHS Foundation Trust
Title HC No. Published Items Response
Seventh Report - Integrated Care Systems: autonomy and accountab… HC 587 30 Mar 2023 30 Responded
Recommendations & Conclusions
30 results
1 Conclusion Accepted
Seventh Report - Integrated Care S…
Integrated Care Systems require balance between local priorities and national accountability.
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 … Read more
Government Response
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.
Department of Health and Social Care
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2 Conclusion Accepted
Seventh Report - Integrated Care S…
DHSC and NHS England must avoid dictating ICS delivery methods for effective integration.
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 … Read more
Government Response
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.
Department of Health and Social Care
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3 Recommendation Acknowledged
Seventh Report - Integrated Care S…
Integrated Care System targets should be outcome-based, with sparingly used delivery prescription.
Targets for ICSs set by DHSC and NHS England should be based on outcomes. There may be times when greater prescription around how targets are achieved is needed, but we believe this should be done sparingly.
Government Response
The government acknowledges the importance of outcomes-based targets and agrees other measures may be needed. They describe a mixed approach to target setting, balancing national and local targets, and highlight existing commitments like the Levelling Up health mission and a reduction in national NHS objectives.
Department of Health and Social Care
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4 Conclusion Accepted
Seventh Report - Integrated Care S…
Local Integrated Care System priorities risk being overshadowed by national directives.
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 … Read more
Government Response
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.
Department of Health and Social Care
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5 Recommendation Accepted
Seventh Report - Integrated Care S…
Explain DHSC mechanisms ensuring progress on local ICS priorities and their national balance.
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 … Read more
Government Response
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 Recommendation Accepted
Seventh Report - Integrated Care S…
Publish proposed shared outcomes framework and ICS implementation details urgently.
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
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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7 Conclusion Accepted
Seventh Report - Integrated Care S…
Short-term pressures risk dominating ICSs, hindering focus on public health and prevention.
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 … Read more
Government Response
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.
Department of Health and Social Care
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8 Conclusion Deferred
Seventh Report - Integrated Care S…
NHS England Long-Term Plan requires update to prioritise prevention and long-term transformation.
NHS England should provide an update on whether they intend to refresh their 2019 Long-Term Plan and, if so, when. Any update to NHS England’s Long-Term Plan must put prevention and long-term transformation at its heart, empowering ICSs to pursue … Read more
Government Response
The government deflected from updating the Long-Term Plan, instead focusing on leadership development and stating that a senior advisory group has been brought together to plan a 3-year roadmap for leadership support.
Department of Health and Social Care
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9 Conclusion Accepted
Seventh Report - Integrated Care S…
Integrated Care Boards lack mandated public health representation, hindering population health outcomes.
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 … Read more
Government Response
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.
Department of Health and Social Care
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10 Conclusion Deferred
Seventh Report - Integrated Care S…
Integrated Care Boards need public health representation; DHSC review required for mandating inclusion.
To guarantee a continual focus on the prevention agenda, all Integrated Care Boards should ensure they include a public health representative, such as a public health director or public health lead. In 12 months, DHSC should conduct a review to … Read more
Government Response
The government deflected from mandating public health representation on ICBs by suggesting that a national peer review offer should be developed by partners within the system.
Department of Health and Social Care
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11 Recommendation Accepted
Seventh Report - Integrated Care S…
ICS success depends on long-term decision-making and assured future funding.
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
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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12 Conclusion Acknowledged
Seventh Report - Integrated Care S…
DHSC requires urgent clarity on providing advance funding information to Integrated Care Systems.
We welcome the Minister’s comments about giving ICSs information about the funding that will be available to them further in advance. DHSC must set out how it intends to do this, and any decision to give that information must be … Read more
Government Response
The government provided a vague commitment, describing how a senior advisory group and system leaders are supporting the implementation and design of new initiatives, but did not specify how it would provide funding information to ICSs earlier.
Department of Health and Social Care
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13 Conclusion Accepted
Seventh Report - Integrated Care S…
ICS leaders need support to develop collaborative system leadership skills, avoiding NHS-centricity.
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 … Read more
Government Response
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.
Department of Health and Social Care
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14 Conclusion Deferred
Seventh Report - Integrated Care S…
Establishing a dedicated ICS leadership development programme is crucial for successful system leaders.
The Government and NHS England should set up and fund an ICS leadership development programme, specifically targeted at supporting leaders of and within ICSs to develop the skills required to be successful system leaders (Paragraph 48) Accountability
Government Response
The government deflected from setting up and funding an ICS leadership development programme, instead discussing local accountability, the role of Oflog, and new performance metrics for various health services.
Department of Health and Social Care
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15 Conclusion Deferred
Seventh Report - Integrated Care S…
Lack of clarity on ICS deliverables hinders public and parliamentary accountability.
We share the concern expressed by the NAO about the lack of clarity around what ICSs are expected to deliver within their core purposes. While we are conscious of, and agree with, the need to avoid micromanaging ICSs, we believe … Read more
Government Response
The government deflected from providing clarity on what ICSs are expected to deliver, instead discussing the public availability of ICB board member information and their discretion in appointing additional members.
Department of Health and Social Care
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16 Conclusion Deferred
Seventh Report - Integrated Care S…
Clear guidance detailing ICS outcomes for core purposes is required from DHSC/NHS England.
Following engagement with ICSs and being conscious of the space required for local priorities, DHSC and NHS England should issue guidance with additional detail on what ICSs are expected to achieve within each of the four core purposes. As we … Read more
Government Response
The government deflected from issuing guidance on what ICSs are expected to achieve within their core purposes, stating that ICB partnership arrangements are discussed in annual assessments and CQC will assess wider ICS partnership working.
Department of Health and Social Care
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17 Recommendation Accepted
Seventh Report - Integrated Care S…
Empowering MPs to directly hold local ICSs accountable requires transparent performance data.
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 … Read more
Government Response
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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18 Recommendation Acknowledged
Seventh Report - Integrated Care S…
Set out how to empower MPs to hold local ICSs accountable with performance measures.
The Secretary of State should set out further detail about how he intends to empower MPs to hold their local ICSs to account and what performance measures he envisages being available to support this.
Government Response
The government offered a vague commitment, supporting the intent to empower MPs but stating that further work will be undertaken as ICSs mature to understand how it could be implemented, given their infancy.
Department of Health and Social Care
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19 Conclusion Acknowledged
Seventh Report - Integrated Care S…
Unclear monitoring and accountability mechanisms for partnership working in ICSs
Partnership working is fundamental to the design of ICSs and will be the make-or- break factor in their success. As we have discussed, the monitoring and evaluation of NHS priorities and structures is well established but it is unclear how … Read more
Government Response
The government made a vague commitment, stating that NHS England's new operating framework includes a commitment to collaborative working and that NHS England will work with ICB leaders to consider how to best support ICBs to mature.
Department of Health and Social Care
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20 Conclusion Deferred
Seventh Report - Integrated Care S…
Need for NHS England to clarify monitoring of partnership working in ICSs
NHS England should provide more clarity about what ICSs should expect in terms of the monitoring of partnership working and how this will be assessed in ICB annual assessments.
Government Response
The government's response discussed the development of a new very senior manager (VSM) pay framework to improve consistency and transparency, which is unrelated to the recommendation about monitoring partnership working in ICSs.
Department of Health and Social Care
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21 Recommendation Accepted
Seventh Report - Integrated Care S…
Action needed from DHSC to resolve issues of poor partnership working in ICSs
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
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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22 Conclusion Acknowledged
Seventh Report - Integrated Care S…
Unclear how government will monitor professional representation on Integrated Care Boards
We have heard a range of compelling arguments for particular professions to have greater representation on Integrated Care Boards and are sympathetic to the concerns that have been raised with us about the exclusion of expertise. However, we are also … Read more
Government Response
The government supports the Hewitt Review's vision for ICS ratings and states DHSC and CQC will work with partners to develop and start testing these ratings in 2024-2025, but does not specifically commit to monitoring professional representation on ICBs.
Department of Health and Social Care
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23 Recommendation Not Addressed
Seventh Report - Integrated Care S…
Imperative for DHSC to centrally gather ICB membership information by October 2023
DHSC should centrally gather information relating to the membership of ICBs, including the specific role of members and their area of expertise, by 1 October 2023.
Government Response
The response is truncated, but based on the visible text, DHSC should centrally gather information and then review it.
Department of Health and Social Care
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24 Recommendation Accepted
Seventh Report - Integrated Care S…
Review gathered ICB membership data to assess representation and policy effectiveness
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 … Read more
Government Response
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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25 Conclusion Acknowledged
Seventh Report - Integrated Care S…
Good patient and carer involvement essential for ICS to meet local needs
The core purposes of ICSs, and the importance of addressing local needs, will not be met without good patient and carer involvement. ICSs cannot truly deliver for their local area without considering the needs of that area from the patient … Read more
Government Response
The government reiterated its commitment to the NHS Long Term Plan and various delivery plans aimed at addressing health inequalities and improving health outcomes, but did not specifically outline actions to ensure or strengthen patient and carer involvement in ICSs.
Department of Health and Social Care
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26 Conclusion Acknowledged
Seventh Report - Integrated Care S…
Opportunity to review Healthwatch funding and commissioning arrangements given new expectations
Given the new expectations that have been placed on Healthwatch organisations across the country, we believe this is a good opportunity to consider their funding and commissioning arrangements.
Government Response
The government acknowledges the opportunity to consider Healthwatch organisations' funding and commissioning arrangements given new expectations.
Department of Health and Social Care
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27 Conclusion Deferred
Seventh Report - Integrated Care S…
Urgent need for DHSC to review Healthwatch funding and commissioning arrangements
DHSC should therefore review the funding and commissioning arrangements for Healthwatch, with a view to ensuring they are fit for purpose within the context of new ICSs, and support Healthwatch to have a clear voice. The outcome of this review … Read more
Government Response
The government response detailed the importance of the prevention agenda, the role of directors of public health, and ICB duties regarding public health, but did not address the recommendation concerning a review of Healthwatch funding and commissioning arrangements.
Department of Health and Social Care
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28 Conclusion Deferred
Seventh Report - Integrated Care S…
Outstanding clarity issues concern CQC's readiness for system assessments from April 2023
Given that the CQC will have the legal powers to conduct assessments from April 2023, it is concerning that there are still outstanding questions that the Government needs to provide clarity on. This is particularly around any priorities DHSC may … Read more
Government Response
The government's response focused on the importance of the prevention agenda and developing methodologies for defining and baselining preventative healthcare spending, completely sidestepping the committee's concern about providing clarity to the CQC on assessment priorities and ratings.
Department of Health and Social Care
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29 Conclusion Deferred
Seventh Report - Integrated Care S…
DHSC needs to urgently clarify CQC assessment decisions and priorities for ICSs
DHSC should urgently provide the CQC with its decision on ratings and any priorities it would like the CQC to focus on. It should also communicate to ICSs what methods will be used to address any areas of concern that … Read more
Government Response
The government response focused on the UK-wide Levelling Up health mission, establishing a cross-government Health Mission Working Group, and the upcoming publication of a toolkit for local shared outcomes frameworks, without providing the requested clarity on CQC ratings or assessment priorities for ICSs.
Department of Health and Social Care
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30 Recommendation Deferred
Seventh Report - Integrated Care S…
Review existing regulatory assessments for ICSs to minimise duplication with DLUHC
DHSC and NHS England should review existing regulatory assessments for ICSs with a view to ensuring there is as little duplication as possible. We recommend this work is done alongside the Department for Levelling Up, Housing and Communities given their … Read more
Government Response
The government response highlighted existing forums and networks available to ICSs for facilitating learning and sharing best practice, but did not commit to reviewing existing regulatory assessments for duplication as recommended.
Department of Health and Social Care
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Government Response AI assessment · 30 of 10 classified
Accepted 12
Acknowledged 7
Deferred 10
Not Addressed 1
Total 10 recs + 20 conclusions
Correspondence 1 letter
6 Jun 2023 Correspondence from the Minister of State in the Department for Health and Social Care on the ICS response date
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