ICBs would like to have a role in provider oversight, according to a survey of ICB leaders.
The survey, by NHS Confederation’s integrated care system (ICS) network, found that 86% of respondents thought they should have a role in provider oversight.
Almost 70% of ICBs favoured a ‘mixed model’, whereby ICBs would be responsible for all provider oversight and not just those with higher capability ratings, as is now the case.
The survey, called System oversight: the view from ICB chairs and chief executives, had 41 respondents, including 24 ICB chief executives and 17 chairs, across 28 ICBs. They were asked about three potential models of provider oversight, one of which was based on NHS England’s draft framework published in June (see box for details).
Three models ICBs were asked about:
- Model 1: The proposed NHS oversight framework is implemented in its current form, i.e. only ICBs with higher capability ratings will have delegated oversight of NHS trusts and foundation trusts.
- Model 2: Changes are made to the proposed oversight framework to remove the link between capability ratings and provider oversight, i.e. meaning that all ICBs would be responsible for provider oversight, not just those with higher capability ratings.
- Model 3: The oversight framework is changed to remove a provider oversight role from ICBs.
Of the respondents, nearly half had concerns that removing oversight would disempower ICBs, while many suggested it may impede system working, make the shift to prevention more challenging, and make it harder to hold providers to account on their contribution to improving population health.
ICBs were also concerned that model three (see box) would make them lose key intelligence and levers, making it harder for them to engage the wider system in solutions.
However, many ICBs also recognised that they are at different stages of maturity, with some not deemed to be ‘ready’ to hold an oversight role.
One ICB leader was worried that the latter risked undermining the principles of the provider oversight role in future.
Some felt that NHS England should support systems to get to the stage where they could deliver oversight to providers with lower ratings.
But, less than 30% of surveyed systems felt they currently had sufficient clarity and support from NHS England to undertake a provider oversight function.
One respondent said: ‘ICBs cannot always see the data that NHSE teams have access to even though it comes from ICS providers. The sort of support that would really make a difference is if NHSE shared their performance reports/unvalidated data so that ICBs are in the best place possible to address issues with providers at the outset.’
It comes after the Darzi report said tensions exist between providers and ICBs, with differing opinions on how far ICBs are responsible for performance management of providers.
He recommended that more consistency was needed, especially given the scale of the ‘performance challenge’.
Since then, health secretary Wes Streeting has announced that underperforming leaders would be managed out as part of a package of reforms, with the NHS Oversight Framework, which sets out how trusts and ICBs are best monitored, to be updated by the next financial year.
ICSs were told earlier this month to implement an overall operational pressures escalation levels (OPEL) score to provide an ‘aggregated view’ of operational pressures across the system.
