The Government should review integrated care board (ICB) membership to ensure each board adequately represents its area’s need, the Health and Social Care Select Committee (HSCSC) has said.
The Committee – made up of MPs – recommended the DHSC review board members’ areas of expertise to determine ‘whether any specialties are especially under-represented’ and if its policy to impose only a few mandated roles is working as planned.
In its new report into autonomy of and accountability for integrated care systems (ICSs) – published today (30 March) – MPs said they were ‘sympathetic’ to reports that some expertise were excluded from boards, but that ICSs had a right to flexibly meet their local needs.
However, they added they were concerned that it was not clear how the Government would assess if this approach ‘is the correct one’, and urged the DHSC to review this by October.
The report said: ‘If data is not held centrally on how many, for example, public health experts or social care providers or clinicians, are on ICBs and no assessment is made of the adequacy of the representation, it is not possible to understand whether the Government’s flexible approach is yielding the results it intends. It will also not be clear whether there are any patterns of under-representation.’
MPs also said that all ICSs should include a public health representative, advising the DHSC to review this is happening in 12 months and ‘if necessary’ mandate their inclusion.
Since their inception, leaders across primary care have cautioned that the new boards may represent a loss of clinical leadership, when compared to their smaller clinical commissioning group (CCG) predecessors.
Steve Brine, MP and committee chair, said: ‘This is a key moment for Ministers and for NHS England. We have found genuine enthusiasm for the potential of Integrated care systems to make a real change, not only in how health and social care is delivered but in prioritising the needs of local populations and preventing ill-health.
‘It would be an opportunity lost if that success was undermined by the need to prioritise central government targets or a focus on meeting short-term demands. We urge Ministers not to lose sight of the crucially important prevention agenda and we call for them to adopt a light-touch outcome driven approach to this new way of working.’
In their new report, MPs also advised the DHSC and NHS England to issue guidance with ‘additional detail’ on what ICSs are expected to achieve within each of the four core purposes.
These – and other – targets should be based on outcomes, with prescription around how targets are achieved only set sparingly.
The Committee also stated that MPs should have the power to hold ICSs to account and the health secretary must detail how he intends to empower MPs to do so.
They said this was ‘an integral part of the role of an MP’, and urged secretary Steve Barclay to outline what performance measures he will enforce to support this.
Sarah Walter director of the NHS Confederation’s ICS Network, said: ‘ICS leaders will be pleased to see the recommendation from the committee that targets for ICS should be outcomes-based, as this will be one of the key drivers or brakes on the ability of ICS to truly transform the delivery of health and social care.
‘Although there is an understandable need to deliver improvements against some of the immediate priorities facing ICS, we would agree with the committee’s position that long-term improvements to care and health outcomes for communities will be dependent on ICS having the capacity to focus on public health, prevention and their role in the local economy.’
Other recommendations include:
- Any update to NHS England’s Long-Term Plan should put prevention and long-term transformation at its heart
- Working with ICSs, the DHSC should set out action to resolve poor partnership working, especially with social care
- The DHSC should urgently provide the CQC with its decision on ratings and priorities it would like the CQC to focus on.