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Avoid ‘prescriptive’ guidance for ICS boards, says NHS chief


By James Hacker
9 March 2021

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Guidance on who can be appointed to an ICS board should not be ‘too prescriptive’ to avoid damaging the success of existing arrangements, Sir Simon Stevens has said.

At Parliament’s second evidence session for the white paper on health and social care, the NHS chief warned that a ‘completely vanilla, one-size-fits-all’ approach to governance would ‘cut across what is already working well,’ and instead called for a ‘permissive framework’.

When asked if guidance should be issued as to who can be appointed to an ICS board, Sir Stevens said: ‘I do think that’s what makes sense, but equally, we don’t want to be too prescriptive, certainly not on the face of the bill as to precisely what that composition should be.

He added that ‘the starting point here is that lots of parts of the country are now already working in this new way, and [have] figured out the right kind of judgments for their local area’.

Sir Stevens suggested that a permissive framework, that allows NHS England to set some guidance through regulation and ‘at least make sure there are the right guarantees in place locally’ was ‘the way to proceed’.

Recommendations to Government

The white paper, published 11 February, set out plans to place ICSs on a statutory footing, which includes CCG functions being taken over by the organisations.

The proposals would bring together the NHS, local government and partners, with a statutory ICS consisting of a statutory ICS NHS body and a separate statutory ICS Health and Care Partnership.

Under the proposals, each ICS NHS body will have a unitary board, which will be directly accountable for NHS spend and performance within the system.

Amanda Pritchard, NHS England and NHS Improvement’s (NHSE&I) chief operating officer – also speaking at the hearing – added that ‘there will be a place’ for guidance on who can be appointed to the boards but agreed that this should not be ‘overly prescriptive’.

She said that NHSE&I had recommended to Government ‘the minimum that you would expect to see around that kind of governance table, both in terms of the ICS body and relationship with the health and care partnership’.

Last month, NHSE&I published its five recommendations on legislation for integrated services, which included that there should be ‘maximum local flexibility’ as to how an ICS health and care partnership is constituted, and that the composition of the board of an ICS body is ‘sufficiently streamlined to support effective decision-making’.

The document said: ‘Legislation should be broadly permissive, mandating only that the members of the NHS ICS Board must include a chair and CEO and as a minimum also draw representation from (i) NHS trusts and foundation trusts, (ii) general practice, and (iii) a local authority.’

This recommendation is reflected in the white paper itself, which also states that ICSs will ‘need to ensure they have appropriate clinical advice when making decisions’.

Ms Pritchard said that NHSE&I is ‘really clear about’ the importance of clinical leadership through the whole of the NHS, and this is as ‘true for PCNs or individual organisations as it will be for ICSs’.

‘But I think we’re just keen to steer away from trying to be overly prescriptive about exactly what that’s going to look like at local level,’ she added.

Impact on patient care

When asked what tangible outcomes the reforms will achieve for patients, Sir Stevens said there must be ‘humility about the role that legislation itself plays in improvement across the health service’.

He said that the bill would make it easier for frontline GPs, among other NHS services, to join services ‘in a way that makes sense locally’, but added that ‘actually implementing the NHS Long Term Plan in the round is what’s going to be required in order to get that kind of join up [of] services’.

The NHS chief said that legislation was key to enabling this and he hoped the changes would ‘overcome the funding silos that the current law creates in a local area’, adding that the NHS has got ‘about as far as we can’ with ‘workarounds to the 2012 Act’.

‘What I mean by that is that the local commissioning groups, the clinical commissioning groups, they have responsibility for planning and funding most community health services and local hospital services,’ he said.

‘But when it comes to, legally at least, GP services, which are really hyperlocal, and then at the other end of the range are specialist services, they are not overseen locally. Statutorily, they are overseen nationally by NHS England.’

He added that the bill will also ‘bring together a wider group of stakeholders to help make those planning judgments: not just groups of GPs on CCG governing bodies, but also other providers, patients groups, local authorities’.

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