- The Department of Health and Social Care, NHS England and NHS Improvement and Local Government Association have published guidance to help systems establish their integrated care partnerships (ICPs). The document aims to ‘start a process of co-production and engagement’ to identify examples of good practice, and gain insights from those with strong partnership arrangements in place.
- We broadly welcome the document and the permissive and flexible approach taken, which allows systems to set up their ICPs to best meet local area needs.
- Our main concern is the lack of guidance on how ICPs are going to be resourced. With the decision left to the ICB and local authorities, we are concerned that this could become a divisive issue when budgets are tight. If ICSs are to be successful, they will need to be effectively funded.
- We will be working with our members to gather their views on this engagement document, to ensure they are shared as part of the engagement process.
What are the requirements for an ICP?
An ICP is a statutory committee, building on existing partnerships and collaboration across the system. ICPs are required:
- to be established in every system
- to have a minimum membership required in law (the integrated care board and local authorities)
- to produce an integrated care strategy for their area.
Integrated care boards (ICBs) and local authorities will be required by law to have regard to the ICP’s strategy when making decisions, commissioning and delivering services.
When do ICPs need to be established?
Integrated care systems (ICSs) can’t be considered fully functioning until they have their ICP set up, as this is a core function. It is expected that all ICSs will have at least an interim ICP up and running by April 2022. An interim ICP needs to include a chair and a committee of at least representatives from the ICB and relevant local authorities, with an agreement for how it will be resourced.
It is expected that ICPs which are in interim form in April 2022 will build up their membership and the hope is that all ICPs will be able to build their membership to a steady state by September 2022.
The selection of an ICP chair will be decided locally, as will the job role and the salary requirements, as these will vary depending on the local needs. There will be no formal definition of any of these elements nationally. It will also be a local decision on how to resource the ICP.
How will ICPs make decisions?
The DHSC is asking for engagement around ideas for principles of good practice when it comes to agreeing the decision-making process for ICPs and may produce further guidance depending on feedback received. It is expected ICPs will engage with a full range of stakeholders to develop their integrated care strategy and to make decisions.
The bill states that the ICP needs to develop an integrated care strategy. However, areas do not have to prepare a new strategy if existing joint health and wellbeing strategies are considered sufficient by the NHS, local authority and community partners. No timescale was given in the document for when the strategy needs to be submitted.
How will the ICP work with the ICB and the local authority?
Both the ICB and the local authority will be statutory members of the ICP so will be directly involved in developing the integrated care strategy and will be equal partners.
Health and wellbeing boards (HWBs)are legislated at place level, while the ICP supports integrated working at a system level. It is expected that ICPs will complement the activities of established HWBs. The place-level knowledge of HWBs will be incredibly useful to ICPs.
An HWB can’t act as an ICP but, depending on the size of the system, ICPs will need to decide the best way to work with their HCBs and what those governance arrangements should be to ensure streamlined working. Local areas can decide how this will work for themselves.
Similarly, ICPs need to work closely with place-based partnerships to support integrated working from place to system level, ensuring they are making best use of the experience and expertise of the place-based partnerships.
The ICP is formed on the principle of equal partnership between the NHS and local government in delivering services. It is expected that each ICP will adopt a model of representation which reflects the diversity of the local provider sector and ensures meaningful engagement with providers of all shapes and sizes.
How does an ICP engage with the public?
ICPs must meet in public and have their meeting minutes and papers available online. As part of the requirement for independent insight and challenge to ICPs from the community, the health and care bill says the ICP must involve the local Healthwatch organisations whose areas coincide with the system area.
It is expected that the people and communities of every system will be fully involved in all aspects of developing the integrated care strategy and ICPs need to set out how they have involved, engaged, and listened to local people, and explain how they have responded to the views given.
ICPs need to develop proposals for engagement with people in their areas, ensuring their plans and strategies deliver what the people need and expect.
How should the ICP represent the community it serves?
ICPs need to ensure they have a diverse and inclusive representation of local communities which the system serves. Annex C of the main document includes a list of the partners ICPs could appoint to the statutory committee or engage with in other collaborative ways and the department is welcoming ideas around others to be added to this list.
What are the five expectations for ICPs?
While the bill is permissive, the department is looking for further engagement around the proposed five expectations for ICPs – full details can be found in the engagement document, but they are:
- ICPs are a core part of ICSs, driving their direction and priorities
- ICPs will be rooted in the needs of people, communities, and places
- ICPs create a space to develop and oversee population health strategies to improve health outcomes and experiences
- ICPs will support integrated approaches and subsidiarity
- ICPs should take an open and inclusive approach to strategy development and leadership, involving communities and partners to utilise local data and insights.
The department will be engaging with local authorities and NHS leaders to start a conversation around the engagement document and the expectations laid out, with a view to then gathering case studies and developing FAQs around the establishment of ICPs. There are several next steps laid out in the document for ICSs to take.
NHS Confederation viewpoint
We broadly welcome the engagement document, but there are several issues we feel need further discussion and clarification.
We are pleased there will be an engagement process around the development of ICPs and we look forward to working with DHSC, NHSEI and the LGA to ensure that ICS members have an opportunity to contribute and provide views.
The flexibility on implementation is helpful; the recognition of place-based working and subsidiarity as important is also a positive step
We welcome that ICP membership can be determined locally, with only ICB and local authority membership set out as mandatory, as well as the recognition that ICSs will be developing at different rates. The flexibility on implementation is helpful. The recognition of place-based working and subsidiarity as important is also a positive step.
The recognition the document gives to the importance of the ICP as a core part of the ICS in setting the strategy and bringing together key partners to ensure that the ICS is a genuine partnership of equals working with and for their partners and communities, is also vital. We were also confident in the wording around the accountability of the ICB to the ICP.
While it is useful to understand the relationship between health and wellbeing boards and ICPs, we are concerned this might cause duplication or complexity for some of the smaller systems, where there is only one HWB operating.
There was also no indication within the document as to the expected timings for the ICPs to develop and produce their first integrated care strategy, which we feel might be a useful guide for ICSs when making their development plans.
Neither local authorities nor NHS ICBs are being given funds to resources ICPs which could cause funding disputes
Our main concern is the lack of guidance on how ICPs are going to be resourced. With the decision left to the ICB and the LAs, we worry this could become a divisive issue when budgets are tight. If ICSs are to be successful, they will need to be effectively funded.
It is clear from the draft ICB resourcing guidance, which covers running costs for ICBs and this engagement document, that neither local authorities nor NHS ICBs are being given funds to resources ICPs, which could cause funding disputes.
We will be working with our members to gather their views on this engagement document, to ensure they are shared as part of the engagement process.