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Clinical leadership ‘decimated’ by the move to ICSs, say leaders

Clinical leadership ‘decimated’ by the move to ICSs, say leaders
By Health reporters
7 December 2022

Health and care leaders decried the loss of clinical leadership in the new NHS system at the Health and social care select committee session on ICSs yesterday.

BMA GP Committee deputy chair, Dr David Wrigley, said that the local clinical leadership and involvement, seen with clinical commissioning groups (CCGs), has disappeared.

‘The Health and Care Act [2022] talked about integration but what we’re seeing is the opposite. That clinical leadership [seen with CCGs] has been decimated, it’s just disappeared,’ he said, adding that ICBs are large and remote and there is a feeling among colleagues of a lack of transparency and accountability.

His thoughts were echoed by Dr Trudi Seneviratne OBE, Royal College of Psychiatrists registrar, who said there were very few mental health clinicians on ICBs.

‘It’s critical we get to a place where clinicians are at the heart of ICBs in the thinking, in how they are set up and that mental health is not lost in the demands on healthcare service,’ she said at yesterday’s session on ICS autonomy and accountability.

National Care Forum chief executive, Professor Vic Rayner OBE, said that the lack of a social care provider voice at the ICB table would result in a failure to plan and prepare for community needs.

‘While we’ve got people sat round the table not understanding that almost all social care provision is delivered outside of local health trusts and local authorities…the challenges we are facing will never be resolved,’ she said.

Dr Wrigley highlighted the BMA analysis of the 42 ICB constitutions which found no role of representation for secondary care clinicians, two with a guaranteed voting position for public health and that 20 don’t mention public health.

‘In the pandemic we saw how important [public health is] but they’ve not got a voice. As a specialty they’ve been completely denuded and taken away from the system when they should be at the forefront,’ he said.

In July Healthcare Leader published a report, CCGs: A post-mortem, to capture the insights of outgoing primary care leaders which warned of the loss of clinical leadership.

A review into the into the accountability of ICSs, led by former labour health secretary and chair of the Norfolk and Waveney ICS, Patricia Hewitt, was announced by chancellor Jeremy Hunt in November.

The Hewitt Review will consider and make recommendations on reducing national targets and empowering local leaders to focus on outcomes.

It will report to health secretary, Steve Barclay, with interim findings by 16 December 2022, a first draft by 31 January 2023 and a final report by no later than 15 March 2023, the DHSC stated yesterday.

Hewitt review: Objectives and scope

The review will consider how the oversight and governance of ICSs can enable them to succeed, balancing greater autonomy and robust accountability with a focus on real time data shared digitally with the DHSC, and on the availability and use of data across the health and care system for transparency and improvement. It will cover ICSs in England and the NHS targets and priorities for which integrated care boards (ICBs) are accountable, including those set out in the government’s mandate to NHS England.

In particular it will consider and make recommendations on:

  • how to empower local leaders to focus on improving outcomes for their populations, giving them greater control while making them more accountable for performance and spending

  • the scope and options for a significantly smaller number of national targets for which NHS ICBs should be both held accountable for and supported to improve by NHS England and other national bodies, alongside local priorities reflecting the particular needs of communities

  • how the role of the Care Quality Commission (CQC) can be enhanced in system oversight

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