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NHS England has published a new document about the design framework for integrated care systems (ICSs) in England, building on UK Government expectations for NHS leaders and organisations to operate with their partners in ICSs from April 2022.

ICSs are a new way of working across NHS and local authorities, which operate by cooperating with one another to manage pressures, pooling resources and budgets, improving patient outcomes and enhancing productivity.

Entitled ‘Integrated Care Systems: design framework’, the latest NHS England document sets out legislative reform to remove barriers to integrated care and to create the conditions for local partnerships to thrive.

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Part of the framework outlines two important aspects of statutory ICS arrangements from next year, subject to the passage of legislation – ICS Partnerships and ICS NHS bodies.

The framework outlines:

  • the functions of the ICS Partnership to align the ambitions, purpose and strategies of partners across each system. This is the broad alliance of organisations and representatives concerned with improving the care, health and wellbeing of the population, jointly convened by local authorities and the NHS.
  • the functions of the ICS NHS body, including planning to meet population health needs, allocating resources, ensuring that services are in place to deliver against ambitions, facilitating the transformation of services, co-ordinating and improving people and culture development, and overseeing delivery of improved outcomes for their population. They will bring the NHS together locally to improve population health and care.

The framework does not attempt to describe the full breadth of future ICS arrangements or role of all constituent partners but focuses on how NHS England and NHS Improvement (NHSEI) expects the NHS to contribute.

The framework is based on the objectives articulated in the UK Government’s recent whitepaper on integrating health and social care. However, content referring to new statutory arrangements and duties, and/or which is dependent on the implementation of such arrangements and duties, is subject to legislation and its parliamentary process.

Therefore, the document recommends that systems do not act as though the legislation is in place or inevitable but rather make reasonable preparatory steps.

The ICS Partnership

The document reads: “Each ICS will have a Partnership at system level established by the NHS and local government as equal partners. The Partnership will operate as a forum to bring partners – local government, NHS and others – together across the ICS area to align purpose and ambitions with plans to integrate care and improve health and wellbeing outcomes for their population.

“The partnership will facilitate joint action to improve health and care services and to influence the wider determinants of health and broader social and economic development. This joined-up, inclusive working, NHS England underlines, is central to ensuring that ICS partners are targeting their collective action and resources at the areas which will have the greatest impact on outcomes and inequalities as we recover from the pandemic.”

Importantly, the UK Government has indicated that it does not intend to bring forward detailed or prescriptive legislation on how these partnerships should operate. Instead, the idea is that each partnership will develop arrangements that work best for them and their local area.

Each ICS Partnership must include members from local authorities that are responsible for social care services in the ICS area, as well as the local NHS. Members might also include those from health and wellbeing boards, housing providers, other statutory organisations and more.

Additionally, the ICS NHS body and local authorities will need to jointly select a partnership chair and define their role, term of office and accountabilities. The appointed ICS Partnership chair could be the same chair of the ICS NHS body but there is also the option to choose a separate chair for each body.

The ICS NHS body

NHS England describes as ICS NHS bodies as: “ICS NHS bodies will be established as new organisations that bind partner organisations together in a new way with common purpose.

“They will lead integration within the NHS, bringing together all those involved in planning and providing NHS services to take a collaborative approach to agreeing and delivering ambitions for the health of their population. They will ensure that dynamic joint working arrangements, as demonstrated through the response to COVID-19, become the norm.

“They will establish shared strategic priorities within the NHS and provide seamless connections to wider partnership arrangements at a system level to tackle population health challenges and enhance services at the interface of health and social care.”

The ICS NHS body will be a statutory organisation responsible for specific functions, including developing a plan to meet the health needs of the population within their area. This covers ensuring NHS services and performance are restored post-pandemic. They will also be responsible for allocating resources to deliver the plan across the system.

Moreover, ICS NHS bodies will establish joint working arrangements with partners that embed collaboration as the basis for delivery of joint priorities within the plan. They might opt to commission jointly with local authorities.

They will further be responsible for establishing governance arrangements to support collective accountability between partner organisations for whole-system delivery and performance, underpinned by the statutory and contractual accountabilities of individual organisations, to ensure the plan is implemented effectively within a system financial envelope set by NHS England and NHS Improvement.

Every ICS NHS body will also arrange for the provision of health services in line with the allocated resources across the ICS through a range of activities, including putting contracts and agreements in place to secure delivery of its plan by providers and working with local authority and VCSE partners to put in place personalised care for people.

In addition, ICS NHS bodies will drive joint work on procurement to maximise value for money across the system.

Importantly, NHS England expects that all clinical commissioning group (CCG) functions and duties will transfer to an ICS NHS body when they are established, along with all CCG assets and liabilities including their commissioning responsibilities and contracts.

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