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‘Inherent tension’ between ICSs’ national and local strategies

‘Inherent tension’ between ICSs’ national and local strategies
By Jess Hacker
17 October 2022

ICSs must navigate an ‘inherent tension’ between their local needs-based strategies and the delivery of national NHS targets, the National Audit Office (NAO) has claimed.

National priorities set out by NHS England and the ‘rigorous oversight mechanisms’ in place to ensure they are delivered may risk overshadowing action on local issues, it said.

In its major review into the setup of ICSs, the NAO highlighted that NHSE has a vast series of mechanisms in place to ensure its national priorities are actioned, including ring-fencing funds, operational and planning guidance, and its Oversight Framework.

But there is no protected budget and far fewer mechanisms are in place to help ICSs progress against their own local objectives, despite Government direction urging them to do so, it warned.

Regardless, the NAO warned that it would not be helpful to set spending expectations or provide national specs for local priorities.

Instead, it simply suggested ICSs must ‘manage these tensions’ if they are to create capacity and resources to respond to local priorities.

Sarah Walter, director of the NHS Confederation’s ICS network, said many of the barriers highlighted by the NAO reflect ICS leaders’ own experiences.

‘Recently, ICS leaders have been growing increasingly concerned by the Government’s lack of attention and coherence across its departments on actions to tackle the wider determinants of ill-health,’ she said.

She also said that the Government must address constrained funding and huge staff shortages, and commit to ‘no further structural reorganisation for the next decade so that the current reforms can be embedded’.

The report also identified that 76% of key stakeholders support the introduction of ICSs, which the NAO noted is in contrast to the strong opposition from Parliament and within the sector to the Health and Care Act 2012 ten years earlier.

But this restructure comes at a time of intense pressure, with around a quarter of trusts and the now defunct CCGs having overspent their budgets in 2019-20.

Local authorities are also facing increasing demand for care services while local government spending power reduced by 26% in the decade up to 2020-21.

The report came as NHSE published its new operating framework last week, which outlined new statutory duties for NHS England and national accountabilities for ICBs.

According to the framework, ICBs are responsible for implementing joint strategies with their partners to meet national commitments, as well as any additional local priorities already agreed in their ICS strategy. It also set out that NHSE is responsible for supporting ICBs and for intervening if its national commitments are not being met.

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