Health and Care Bill: Integrated Care Boards and local health and care systems
Updated 10 March 2022
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Sir Simon Stevens, NHS chief executive, said:
This Bill contains widely supported proposals for integrated care, which have been developed and consulted on over recent years by the NHS itself. They go with the grain of what our staff and patients can see is needed, by removing outdated and bureaucratic legal barriers to joined-up working between GPs, hospitals and community services.
In doing so, these pragmatic reforms build on the sensible and practical changes already well underway right across the NHS. And by enabling mutual support between different parts of the local health and care services they will undoubtedly both help tackle health inequalities and speed the recovery of care disrupted by the COVID pandemic.
Rob Webster CBE, Chief Executive, West Yorkshire and Harrogate Health and Care Partnership, said:
One of the real strengths of our ICS has been the emphasis on shared purpose and real ambitions, such as tackling health inequalities for colleagues and communities from ethnic minority groups, for people with a learning disability and enduring mental illness. We have 10 such big ambitions agreed collectively and to be delivered in collaboration. It is great to see the permissive nature of the legislation which allows for systems like ours to build on the progress we have made, and to drive delivery through partnerships in places and provider collaboratives.
Professor Claire Fuller, Surrey Heartlands ICS Lead, said:
Integrating care makes a huge difference to the population when we get it right, and I have seen the benefits it can bring for both patients and for those of us working in health and care. I am therefore really pleased that we will now be pressing ahead with this agenda through the Health and Care Bill, and I hope we can collectively seize the opportunities it brings.
This fact sheet explains how the government plans to establish Integrated Care Boards and Integrated Care Partnerships.
Background
COVID-19, and experience over the last few years has demonstrated the importance of different parts of the health and care system working together in the best interests of the public and patients, despite the legislative barriers.
The proposed Health and Care Bill implements NHS England’s recommendations to support integration by legislating for every part of England to be covered by an Integrated Care Board (ICB) and Integrated Care Partnership (ICP). This builds on the existing non-statutory ICSs across England.
What the Bill will do
The Bill will allow for the establishment of Integrated Care Boards and Integrated Care Partnerships across England. This will be done at the same time as abolishing Clinical Commissioning Groups (CCGs).
The ICB will take on the NHS commissioning functions of CCGs as well as some of NHS England’s commissioning functions. It will also be accountable for NHS spend and performance within the system.
The Board of the ICB will, as a minimum, include a chair, the CEO and representatives from NHS providers, general practice and local authorities. Beyond that, ICBs will have the flexibility to determine governance arrangements in their area – including the ability to create committees and delegate functions to them. This would, for example, allow systems to create local ‘place’-based committees to plan care where appropriate. ICBs will also need to ensure they have appropriate clinical advice when making decisions.
NHS England will agree ICBs’ constitutions and will hold them to account for delivery.
We are also enabling the transition of commissioning responsibilities for primary care services to ICBs. Currently, this sits with NHSE, but primary medical care services have been successfully delegated to CCGs for some time. The intention is that ICBs could be responsible for the commissioning and arranging of primary medical services, dentistry (primary, community and secondary services), community pharmacy and general ophthalmology in the future with NHS England retaining a more limited oversight role.
Staff currently employed by CCGs will transfer to ICBs, and NHS England has made an employment commitment to staff to provide stability and minimise uncertainty.
Each area will also have an Integrated Care Partnership or ICP, a joint committee which brings together the ICB and their partner local authorities, and other locally determined representatives (for example from health, social care, public health; and potentially others, such as social care or housing providers).
The ICP will be tasked with developing a strategy to address the health, social care and public health needs of their system, and being a forum to support partnership working. The ICB and local authorities will have to have regard to ICP strategies when making decisions.
The ICB and ICP will also have to work closely with local Health and Wellbeing Boards (HWBs) as they have the experience as ‘place-based’ planners, and the ICB will be required to have regard to the Joint Strategic Needs Assessments and Joint Local Health and Wellbeing Strategies (JHWSs) produced by HWBs.
How these provisions will help to promote integration
While ICBs are NHS bodies, local authorities are included as members of its Board, strengthening collaborative working. Other complementary Bill proposals will also facilitate greater ease in pooling of budgets.
ICBs and ICPs will also strengthen partnerships between the NHS and local authorities, and with local partners, including groups representing the public and patient perspective, the voluntary sector, and wider public service provision. We expect these bodies to support a change of culture towards greater collaboration and joint working, something we have already seen in several of the more advanced ICSs established on a voluntary basis.
The legislation does not seek to define a ‘place’ as something within a system, but recognising the importance of ‘places’ in making integration happen, it is designed to ensure that place-based arrangements are as effective and collaborative as possible, and are supported by co-operation at system level.
Integration in the ‘real world’
Somerset Integrated Care System
Thousands of people in Somerset looking for help with mental health are getting faster joined-up care thanks to the Open Mental Health partnership, which includes a helpline they can access 24 hours a day.
The scheme, which is part of the Somerset Integrated Care System, has brought together doctors, nurses, psychologists, and charities such as Age UK, Citizen’s Advice, Rethink Mental Illness and many others.
The trailblazing scheme has also tightly linked the voluntary sector into the NHS through the development of a shared system for recovery and care planning, so all professionals involved in the person’s care will be able to write and respond to each other.
Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System
Joined up health and social care teams in Oxfordshire identified a low uptake in bowel cancer screening by men in Wantage and sent social prescribers to support them to take up the offer.
Staff from the primary care network, Cancer Research UK, Age UK and other stakeholders in the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System, worked together to design the system to improve cancer outcomes.
The key benefits include the close relationships developed in the primary care network team especially the social prescribers and care coordinators, an enthusiasm for a proactive approach to improving health and wellbeing of a vulnerable group, and developing new partnerships with other organisations such as Cancer Research UK.
Greater Manchester Integrated Care System
The Greater Manchester Mentally Healthy Schools and Colleges initiative brings together NHS, local authority and partners from the voluntary, community and social enterprise sector to support the mental health of children and young people in schools and colleges.
The programme promotes young people’s mental and physical health, building the confidence of teachers, support staff and students to talk about and address mental health concerns. The initiative trains staff and students in mental health first aid and to become mental health champions, and provides one-to-one support for the most vulnerable children with trained mental health workers.
One in 10 schools in Greater Manchester (125 in total) are supported by the scheme. An independent evaluation of the impact over 6 months on the first schools to participate showed that 175 school staff received mental health first aid training and reported feeling more confident and able to deal with it as a result.
Further information
The NHS Long Term Plan, January 2019
The NHS’s recommendations to Government and Parliament for an NHS Bill, September 2019
NHS England & NHS Improvement, Implementing the Long Term Plan: Proposals for possible changes to legislation, February 2019
Department of Health and Social Care, Integration and Innovation: working together to improve health and social care for all, February 2021
NHS England and NHS Improvement, legislating for Integrated Care Systems: 5 recommendations to government and Parliament, February 2021
NHS England and NHS Improvement, Integrated Care Systems: design framework, June 2021