Since 2016, health and care organisations have increasingly been working together in England to coordinate services and to improve population health and reduce inequalities between different groups. The formation of non-statutory ICSs accelerated this change.
ICSs were voluntary coalitions bringing together NHS providers, local authorities, and voluntary sector partners to collaboratively plan and organise how health and care services were delivered in their area. CCGs were the statutory bodies responsible for commissioning and planning of health care services in a local area. There were 42 ICSs across England, and each covered a population size of 1 to 3 million. The goal was to remove barriers between organisations to deliver better, more joined up care for local communities.
This Act moves these voluntary coalitions onto a statutory footing by establishing statutory ICBs. The ICBs will take on the commissioning functions of CCGs as well as some of NHS England's commissioning functions. However, an ICB is not simply a larger CCG. The ICB governance model reflects the need for integration and collaboration across the system. An ICB will have the ability to exercise its functions through place-based committees (while remaining accountable for them) and it will also be directly accountable for NHS spend and performance within the system.
The ICB will, as a minimum, include a chair, chief executive officer, and representatives from NHS trusts and NHS foundation trusts, general practice, and local authorities. The chair must ensure that at least one ordinary member has knowledge and experience of mental health services. Beyond that, local areas will have the flexibility to determine any further representation in their area. ICBs will also need to ensure they have appropriate clinical advice when making decisions.
Each ICB and its partner local authorities will be required to establish an integrated care partnership (ICP), bringing together health, social care, public health, and representatives from the wider public space where appropriate, such as social care providers or housing providers. The ICP will be tasked with developing a strategy to address the health, social care, and public health needs of its system. The ICB and local authority (or authorities) will have to have regard to that plan when making decisions.
The Act introduces a new duty on the CQC to conduct reviews of ICBs, local authorities and their system partners working collectively. These reviews will assess the provision of NHS care, public health, and adult social care within the ICB area. They will consider how well the ICBs, local authorities, and CQC registered providers discharge their functions in relation to the provision of care as well as the functioning of the system as a whole, which will include the role of the ICP.