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
12 results
Clear
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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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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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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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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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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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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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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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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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
Parliament page