Introducing Integrated Care Systems

Public Accounts Committee Closed Inquiry
Opened: 30 Sep 2022 Closed: 13 Apr 2023 Parliament page
NHS services in England were commissioned by Clinical Commissioning Groups (CCGs). The Health and Social Care Act 2022 abolished CCGs and replaced them with 42 Integrated Care Systems (ICSs) in England from 1 July 2022. ICSs are made up of an Integrated Care Board, of NHS bodies, and an Integrated … Read more
10 Recommendations
10 Conclusions
1 Report
1 Oral session
3 Letters
1 Event
Activity timeline 7 events
12 Apr
2023
Report published
28 Mar
2023
Correspondence
8 Feb
2023
Report published
6 Dec
2022
Correspondence
29 Nov
2022
Correspondence
3 Nov
2022
Oral evidence
3 Nov
2022
Formal meeting (oral evidence session) · The Grimond Room, Portcullis House
Oral evidence sessions 1 session
3 Nov 2022
View on parliament.uk
Introducing Integrated Care Systems
Amanda Pritchard · NHS England Edward Waller · NHS England Matthew Style · Department of Health and Social Care Sir Chris Wormald · Department of Health and Social Care
Title HC No. Published Items Response
Thirty-Fifth Report - Introducing Integrated Care Systems HC 47 8 Feb 2023 20 Responded
Recommendations & Conclusions
20 results
2 Recommendation Accepted
Thirty-Fifth Report - Introducing …
We remain very concerned about the critical shortages across the NHS workforce and the Department’s...
We remain very concerned about the critical shortages across the NHS workforce and the Department’s repeated delays in publishing a strategy to address them. Workforce shortages are widespread across the NHS, and particularly acute in some specialisms, for example midwifery. … Read more
Government Response
The government agrees with the recommendation and will publish a long-term workforce plan for the NHS in 2023.
HM Treasury
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3 Recommendation Rejected
Thirty-Fifth Report - Introducing …
The Department has started taking some action to address workforce challenges in social care, but...
The Department has started taking some action to address workforce challenges in social care, but vacancies have increased by 50% in the last year and the number of people working in social care fell in 2021/22 for the first time … Read more
Government Response
The government disagrees with the committee’s recommendation to provide a breakdown of how it spent and what impact it achieved and to set out the underlying reasons and forecasts for social care vacancies. The department will publish additional information on what it is doing to support care commissioners and employers improve workforce capacity, including an update on its workforce reform programme and international recruitment.
HM Treasury
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4 Recommendation Rejected
Thirty-Fifth Report - Introducing …
These reforms do nothing to address the longstanding tension caused by differences in funding and...
These reforms do nothing to address the longstanding tension caused by differences in funding and accountability arrangements between the NHS and social care. The Department, which has policy responsibility for both health and social care, is showing a worrying lack … Read more
Government Response
The government disagrees with the recommendation to publish guidance for ICSs on resolving joint working issues, stating that the existing structures and processes are designed to ensure partners support each other.
HM Treasury
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5 Recommendation Accepted in Part
Thirty-Fifth Report - Introducing …
The NHS estate is in an increasingly decrepit condition, but the Department seems unable to...
The NHS estate is in an increasingly decrepit condition, but the Department seems unable to make timely decisions to address these problems. The NAO report found that the cost of tackling outstanding maintenance work on the NHS estate has now … Read more
Government Response
The government agrees with the committee’s recommendation for a capital strategy, but suggests that updates are provided to the Committee as necessary rather than annually. Decisions affecting capital projects will be communicated via regular channels.
HM Treasury
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6 Recommendation Accepted
Thirty-Fifth Report - Introducing …
NHS funded dental care is in crisis in some parts of the country, and NHS...
NHS funded dental care is in crisis in some parts of the country, and NHS England’s failure to ensure people can access routine dental care is leading to more acute dental health problems. NHS England, rather than ICSs, remains responsible … Read more
Government Response
The government agrees with the committee’s recommendation and sets out the funding intended for NHS dentistry in 2022/23 and 2023/24. The government outlines several measures taken to secure recovery of dental access, improve accessibility and indicates people can attend any dentist accepting NHS patients and where the person is unable to secure an appointment, or they are unknown to a dental practice then they should contact NHS 111 for assistance to find an emergency or urgent appointment.
HM Treasury
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1 Conclusion Accepted
Thirty-Fifth Report - Introducing …
On the basis of a report by the Comptroller and Auditor General, we took evidence...
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health & Social Care (the Department) and NHS England about the introduction of Integrated Care Systems (ICSs) in England.1
Government Response
The government agrees with the Committee’s recommendation and states Integrated Care Systems will provide tangible benefits for local population, including the delivery of commitments that are set out in the government’s mandate to the NHS England and accompanying documents.
HM Treasury
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7 Conclusion
Thirty-Fifth Report - Introducing …
We are concerned ICSs may struggle to make progress on their longer-term aims to prevent...
We are concerned ICSs may struggle to make progress on their longer-term aims to prevent ill-health, given pressure for progress on immediate national priorities, for example, the need to reduce elective care backlogs and bring down A&E and ambulance waiting … Read more
HM Treasury
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8 Conclusion
Thirty-Fifth Report - Introducing …
We are also concerned about the lack of progress on preventing ill-health rather than simply...
We are also concerned about the lack of progress on preventing ill-health rather than simply treating it.17 There also do not appear to be effective joint working arrangements between different government departments to tackle the causes of ill-health.18 The Department … Read more
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9 Conclusion Accepted
Thirty-Fifth Report - Introducing …
The threadbare provision of NHS funded dental care is a further example of a failure...
The threadbare provision of NHS funded dental care is a further example of a failure to provide preventative or protective routine care leading to more acute health problems.24 NHS England, rather than ICSs, remains responsible for most of NHS dentistry … Read more
Government Response
The government agrees with the committee's concerns and states that securing recovery of dental access is a key NHS priority, outlining existing measures such as funding allocations and reforms to the national dental contract.
HM Treasury
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10 Conclusion Accepted
Thirty-Fifth Report - Introducing …
However, NHS England was unable to tell us how many more dentists it expected these...
However, NHS England was unable to tell us how many more dentists it expected these reforms to produce, or by when they would appear. It told us that a sustainable solution required further engagement with the dental profession on the … Read more
Government Response
The government agrees with the committee's concerns and states that securing recovery of dental access is a key NHS priority, outlining existing measures such as funding allocations and reforms to the national dental contract.
HM Treasury
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11 Conclusion Rejected
Thirty-Fifth Report - Introducing …
There is a well-established interdependency between health and local government, with local authorities responsible for...
There is a well-established interdependency between health and local government, with local authorities responsible for managing local social care markets. The stability and resilience of social services have a direct impact on the NHS. High-quality social care, if available, can … Read more
Government Response
The government disagrees with the committee's recommendation, stating that the Health and Social Care Act 2022 is designed to ensure partners support each other and that they will take action if arrangements are not working.
HM Treasury
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12 Conclusion Rejected
Thirty-Fifth Report - Introducing …
The oversight of ICSs largely focuses on the NHS elements, and we are concerned the...
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 … Read more
Government Response
The government disagrees with the Committee's recommendation, stating that the Health and Social Care Act 2022 is designed to ensure partners support each other and that they will take action if arrangements are not working.
HM Treasury
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13 Recommendation Rejected
Thirty-Fifth Report - Introducing …
NHS England noted the importance of ICSs’ Integrated Care Boards working constructively with the full...
NHS England noted the importance of ICSs’ Integrated Care Boards working constructively with the full range of local partners, including local government, elected members, community groups and the voluntary sector.40 We highlighted the necessity of MPs being able to raise … Read more
Government Response
The government disagrees with the recommendation, stating that the Health and Social Care Act 2022 is designed to ensure partners support each other and resolve issues together, further reinforced by the NHS Act 2006's duties to co-operate.
HM Treasury
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14 Conclusion Deferred
Thirty-Fifth Report - Introducing …
ICSs must contend with the legacy of an increasingly decrepit NHS estate and infrastructure.
ICSs must contend with the legacy of an increasingly decrepit NHS estate and infrastructure. The NAO’s report highlights that the cost of the work needed to bring the NHS estate back up to scratch has increased from just under £5 … Read more
Government Response
The government agrees and states that plans for a capital strategy remain under consideration, and the strategy is intended to be published within 2023.
HM Treasury
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15 Conclusion Deferred
Thirty-Fifth Report - Introducing …
We asked the Department about the limited extent of capital investment in the NHS.
We asked the Department about the limited extent of capital investment in the NHS. It told us that it had taken an explicit decision to reduce capital investment prior to the COVID-19 pandemic in the interests of managing budgets but … Read more
Government Response
The government agrees and states that plans for a capital strategy remain under consideration, and the strategy is intended to be published within 2023.
HM Treasury
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16 Recommendation Accepted
Thirty-Fifth Report - Introducing …
We have been raising concerns about the lack of long-term planning for the NHS workforce...
We have been raising concerns about the lack of long-term planning for the NHS workforce since well before the COVID-19 pandemic52. We have noted that among comparable OECD countries the UK has relatively low numbers of nurses and doctors per … Read more
Government Response
The government commits to publishing a long-term workforce plan for the NHS in 2023.
HM Treasury
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17 Conclusion Deferred
Thirty-Fifth Report - Introducing …
The January 2019 NHS Long Term Plan originally committed to producing a workforce implementation plan...
The January 2019 NHS Long Term Plan originally committed to producing a workforce implementation plan by late 2019. In September 2020, the Department told us that it expected to publish the workforce plan following the December 2020 Spending Review.59 In … Read more
Government Response
The government agrees and committed to publishing a long-term workforce plan for the NHS in 2023.
HM Treasury
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18 Recommendation Deferred
Thirty-Fifth Report - Introducing …
The social care workforce is in a similarly precarious position, against a wider backdrop of...
The social care workforce is in a similarly precarious position, against a wider backdrop of declining local authority resources.64 Despite the Department’s assurances that “the numbers are moving in the right direction”, vacancies in social care have been on an … Read more
Government Response
The government agrees with the recommendation but defers implementation until April 2025, when interim findings of its formal evaluation of workforce reform initiatives will be available; an update on the breakdown of spend will be available in April 2024 and a plan for adult social care system reform will be published in Spring 2023.
HM Treasury
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19 Recommendation Rejected
Thirty-Fifth Report - Introducing …
The Department told us numbers in the social care workforce were going in the right...
The Department told us numbers in the social care workforce were going in the right direction and that domiciliary care and care home workforces were expanding.70 However, written evidence sent to us by the National Care Forum highlights that, as … Read more
Government Response
The government disagrees with the Committee’s recommendation, stating that they don't hold further information to explain the underlying reasons for social care vacancies and don't produce forecasts for vacancies.
HM Treasury
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20 Recommendation Deferred
Thirty-Fifth Report - Introducing …
We asked the Department what the £500 million Adult Social Care Discharge Fund would achieve.
We asked the Department what the £500 million Adult Social Care Discharge Fund would achieve. It informed us this funding would be used primarily for measures to support discharge from hospitals into social care, with an expectation that much would … Read more
Government Response
The government provided £500 million to support safe discharge from hospital into social care and will publish joint plans from local authorities and NHS integrated care boards shortly; it will provide more detailed analysis and findings of the fund's evaluation in summer 2023.
HM Treasury
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Government Response AI assessment · 18 of 10 classified
Accepted 6
Accepted in Part 1
Deferred 5
Rejected 6
Total 10 recs + 10 conclusions
Correspondence 3 letters
28 Mar 2023 Correspondence from Amanda Pritchard, Chief Executive Officer, NHS England, re Treasury Minute Thirty-Five (Establishing Integrated Care Systems) Recommendation Six, dated 30 March 2023
Parliament page
6 Dec 2022 Correspondence from Amanda Pritchard, Chief Executive Officer, NHS England, re Public Accounts Committee 3 November oral evidence session on Introducing Integrated Care Systems – follow up actions, dated 26 November 2022
Parliament page
29 Nov 2022 Correspondence from Sir Chris Wormald, Permanent Secretary, Department of Health and Social Care, re follow up information from the PAC on ICSs, dated 18 November 2022
Parliament page