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‘More sophisticated’ model of accountability needed for ICSs, says NHS Providers

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By Jess Hacker
4 March 2021

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Integrated Care Systems (ICSs) require a ‘more sophisticated’ model of accountability than what has so far been set out in the latest proposals for NHS reform, NHS Providers has said.

Speaking on 2 March during Parliament’s first evidence session for the inquiry into the white paper on health and social care, Chris Hopson, chief executive of NHS Providers, said that the matter of which body ICSs are accountable to is lacking in detail.

He said: ‘I do think the accountability question is a very important one, and for us it is a classic illustration [that] there is a huge amount of detailed work that still needs to be done.’

Mr Hopson added that when NHS Providers had asked officials working on the bill who ICSs would be accountable to, the response was ‘of course to NHS England and Improvement’.

‘I think our view is that we need a much more sophisticated model of accountability than that,’ he said.

‘So for example, we’re putting £100bn of public money through ICSs – that’s 11% of total UK public expenditure – so my assumption would be that ICSs would have to be responsible to Parliament, through the department, through NHS England and Improvement.’

Independence and accountability

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.

Under the proposals, a statutory ICS will be made up a statutory ICS NHS body and a separate statutory ICS Health and Care Partnership, bringing together the NHS, local government and other partners, such as community health providers.

The white paper said that the proposals as a whole focus on ensuring that accountability arrangements ‘command public confidence’ while also enabling systems ‘to get on with doing their jobs’.

On ICS accountability specifically, it said: The Department will support the independence and accountability of ICSs, and the Secretary of State for Health and Social Care will have an important role in ensuring that integration across health, public health and social care is working effectively within these systems.’

The document also states: ‘NHS services and organisations are scrutinised by local authority overview and scrutiny committees and work with them closely on a number of issues – but their primary form of democratic accountability is (via NHS England) to national government and ultimately to Parliament.’

It added that this ‘will be important to recognise and reflect in the legislation’.

‘Duplication and overlap’

The issue of bureaucracy was also raised in the evidence session, with Paul Bristow MP asking what permissions should be in the bill to ensure that existing bureaucratic burdens on ‘various NHS institutions’ are ‘not replaced by new burdens’ on the ICS NHS Body and Partnership.

In response to this, Mr Hopson said ‘we do have a worry here’ because of the multiple organisations now in the health system, including primary care networks, trusts and foundations, providers – and the move to now put ICSs on a statutory footing.

He added that there was a need to be ‘very clear’ about what each one of these bodies does, what its accountabilities are, how its governance structures, and how all of that will work together.

‘There is a danger that if you have that many players on a pitch, there is an opportunity for duplication and overlap,’ he said.

‘So we just need to be sure about exactly how we’re going to define those accountabilities and how we’re going to define those responsibilities.’

‘Further clarity’

The white paper also states that the creation of the ICS NHS Body will allow NHS England to have an ‘explicit power’ to set a financial allocation or other financial objectives at a system level.

‘NHS providers within the ICS will retain their current organisational financial statutory duties, however this will also be supplemented by a new duty to compel them to have regard to the system financial objectives so both providers and ICS NHS boards are mutually invested in achieving financial control at system level,’ the document said.

Mr Hopson told Healthcare Leader that it would be important to closely scrutinise further detail ‘to ensure the clarity around local accountabilities in the current legislation is maintained’.

‘DHSC states that providers will retain their current organisational financial statutory duties but there will be an additional duty on providers to have regard to the system financial objectives. Further clarity about how these two duties will work in practice and what mechanism will be in place to manage any conflicting priorities would be welcome,’ he said.

He added: ‘This is all the more important because we know delivering frontline healthcare services is complex, costly and risky. NHS trusts, for example, spend over £90 billion a year, employ over 800,000 staff and significant numbers of lives can be lost unnecessarily if things go wrong.

‘As the Mid Staffs inquiry showed, it’s vital everyone is completely clear about who is responsible and accountable for what. At the moment trust boards are totally accountable for all that happens within their trust, and we blur that clarity at our peril.’

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