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ICSs might fail because they are not statutory bodies, PAC report warns


By Valeria Fiore
Reporter
4 April 2019

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The success of integrated care systems (ICSs) might be hindered by the fact that they are not statutory bodies and rely on goodwill and local working relationships, a report has warned.

Published yesterday, the Public Accounts Committee (PAC) report on the financial sustainability of the NHS said the success of ICSs could be hampered by the fact that it will be dependent on ‘strong and constructive local working relationships’, which could take years to develop.

Challenges under the current framework

The report concluded that under the current legal and regulatory framework it is difficult for the NHS to work as a system.

It said: ‘The current system holds individual organisations to account, and it is individual organisations that are subject to inspection by the Care Quality Commission.’

ICSs, on the other hand, have no legal status and are not subject to CQC inspection, the report said.

PAC, which took evidence from bodies including NHS England, NHS Improvement, NHS Providers and the Department of Health and Social Care (DHSC) on the financial viability of the NHS, believes that under the current legal frameworks, organisations might find face difficult situations when making decisions as an ICS.

The report said: ‘For example, sometimes chief executives need to make decisions that might not be in the best interests of their organisation, which they are held accountable for, but will be in the best interests of the system.’

The report recommended that NHS bodies and the DHSC should write to the committee by July 2019 to clarify governance arrangements for the formation of effective ICSs.

More detail is also needed around how ICSs can align the responsibilities  of the different NHS bodies within them to drive system change and how areas with less developed partnership working will be supported, the report said.

Underestimated long-term plan challenges

The PAC also argued that the NHS and the DHCS have ‘painted an overly positive picture of the future financial sustainability of the NHS, lacked detail on delivering the NHS long-term plan, and underestimate the challenges the NHS faces in delivering its long-term plan’.

Among the recommendations put forward in the report, PAC said that the NHS should write to them by July to clarify how it intends to address workforce shortages, which they believe present a challenge to the delivery of the long-term plan.

PAC also invited the NHS to provide more details around how trusts are expected to achieve annual financial balance –in accordance with the long-term plan objective for no trust to report a deficit by 2023/24.

PAC added that it would like this clarification included in the planning guidance for 2020/21.

Commenting on the report, PAC chair Meg Hillier said:  ‘Staff shortages are a clear threat to the delivery of the NHS long-term plan and by July we expect to see evidence that Government has a plan to address them.

‘If the long-term plan is to be more than just an aspiration then Government must engage fully with the detail and ensure necessary resources are directed to the right places.’

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