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ICSs will fail unless Government addresses core NHS crises

ICSs will fail unless Government addresses core NHS crises
By Jess Hacker
8 February 2023

Major reforms to the NHS, namely the introduction of Integrated Care Systems (ICSs), will fail unless the Government tackles core crises facing the health service, the Public Accounts Committee (PAC) has said.

The MPs warned that the new systems have not shown any ‘tangible benefits’ to patients, with no specific goals set for when or how care can be expected to improve.

The systems are further undermined by the Government’s ‘lack of leadership’ and ‘failure’ to tackle major systemic issues facing the NHS, including its critical workforce shortages, elective backlogs, and the NHS’ relationship with social care, the PAC said in a new report published today (8 February).

All 42 ICSs became statutory bodies in July 2022, taking over the commissioning responsibilities previously held by the now defunct clinical commissioning groups (CCGs).

The PAC has now called on the Department of Health and Social Care (DHSC) to publish its comprehensive workforce plan, the absence of which has placed ‘significant restraints’ on ICS’ ability to deliver on their core aims.

The report said: ‘The Department has repeatedly failed to make good on its commitments to produce a plan to address this issue, and now many areas of the NHS workforce appear to be in crisis.’

The workforce plan was first committed in the January 2019 NHS Long Term Plan, set to be implemented by 2019’s end. This was delayed until December 2020, before eventually being commissioned in July 2021, with a view of publishing it by Christmas 2022.

The DHSC had also declined to commit to the PAC’s request to publish the plan by April 2023.

The Committee also claimed the ‘integrated’ element of ICSs appears ‘underdeveloped’, marked by a ‘concerning lack of oversight’.

It pointed in particular to the lack of leadership from the DHSC on the expected relationship between health and social care, and the lack of clarity as to who will intervene if joint working between the NHS and other partners breaks down.

The PAC said it was concerned these reforms will be a ‘missed opportunity’ if guidance is not published to set out how the NHS and local government can work together.

MPs also suggested it is ‘unclear’ what ‘tangible benefits patients will see from the move to ICSs’, flagging that the timescales for improvements – which range from three to 10 years – are ‘worryingly long’.

This is worsened by both the DHSC and NHS England neglecting to set out what specific benefits they expect from ICSs, or by when, the Committee said.

They said: ‘We are concerned ICSs may struggle to make progress on their longer-term aims to prevent ill-health, given pressure for progress on immediate national priorities, for example, the need to reduce elective care backlogs and bring down A&E and ambulance waiting times.’

The PAC also called on the Government to publish its capital strategy in early 2023 followed by annual progress updates, claiming the DHSC seems ‘unable to make timely decisions to address’ the worsening estates issue.

The cost of tackling outstanding maintenance work on the NHS estate has grown from £5bn to £9bn over the last seven years.

Dame Meg Hillier MP, Chair of the Public Accounts Committee, said: ‘Far from improving the health of the nation, staff shortages and the dire condition of the NHS estate pose a constant risk to patient safety. But Government seems paralysed, repeatedly rethinking and delaying crucial interventions and instead coming up with plans that do nothing to address the fundamental problems of funding and accountability.

 ‘The ICS reforms have potential but there is no clear responsibility for ensuring that social care is properly integrated with health care or that patients will see the difference on the ground. Changes will not succeed if they are imposed on the NHS in its current state. Government needs to get a grip on the wider, full-blown health and social care crisis it allowed to develop from long before the pandemic.’

Last week, a Healthcare Leader investigation revealed that at least £64.6m of funding available under the additional roles reimbursement scheme (ARRS) this year is currently forecast to go unspent, with ICBs expected to reallocate just 13% of it.

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