If enacted as planned, the majority of the Health and Care Bill will become law in
April 2022, including a key focus on developing system working and formalising ICSs as statutory bodies. It will put ICSs on a two-part footing, comprising a new statutory body in the integrated care board (ICB), bringing together the organisations that plan and deliver NHS services within the ICS' geographic footprint, and a statutory committee in the integrated care partnership (ICP), a broader alliance of organisations across health, social care, public health and wider partners. The core purpose of ICSs will be to improve outcomes, tackle health inequalities, enhance productivity and support social and economic development.
NHS England and NHS Improvement is rolling out guidance and frameworks to support the development of ICSs, such as its Integrated Care Systems: design framework, Interim guidance on the functions and governance of ICBs, as well as guidance on place, provider collaboratives, ICS people function, and engagement with communities, which will serve as key components of system working and ICS delivery. It has also published a model constitution, which aims to support the development of ICB constitutions including the composition of the board and appointment processes. NHS England and NHS Improvement recognises the broad and diverse ways in which providers and system partners are collaborating and therefore sets out its intention for a flexible operating model for ICSs and the organisations within them. These guidance documents aim to support trusts, and ICSs, with the shift towards collaborative working arrangements and help partners within ICSs to develop their joint working arrangements at place and ICS level ahead of April 2022.
Critically, trust boards will continue to be accountable for quality, safety, use of resources and compliance with standards, and in future the delivery of any services or functions delegated to them by the ICS. Many trusts have already established or are in the process of setting up collaboration arrangements, accelerated by joint working during the COVID-19 pandemic. There is now an expectation for all trusts providing acute and mental health services to be part of at least one provider collaborative, while guidance states that other trusts (such as community and ambulance trusts) should be part of one where this 'makes sense'. Given the importance of collaboration to all trust types, we continue to argue for more inclusive wording in national policy guidance.
These changes to the health and care landscape are taking place within the context of the COVID-19 pandemic, characterised by significant additional operational pressure from COVID-19 cases, the need to restore services, tackle backlogs of care, and meet deferred demand across urgent and emergency care, mental health and community health services. This includes a combination of patients with unmet need coming forward for treatment, often in a more advanced clinical position as a result of or exacerbated by the pandemic. Staff burnout is also a key concern, with 48% of trust leaders saying that they had seen evidence of staff leaving their organisation due to early retirement and effects of working through the pandemic. ICSs, and their constituent organisations, will therefore need to navigate these changes to system working within this challenging context. There will be a need for future regulatory frameworks to be supportive, flexible and reflect an understanding of the level of disruption caused and ongoing challenges brought about by the pandemic.
ICSs will be expected to maintain momentum on improving outcomes and support trusts with COVID-19 recovery within a set financial envelope and, under the new system oversight framework, to take on some responsibilities for the oversight of trusts. Regulation of provider and system performance and the quality of care will therefore be taking place within a new and rapidly changing architecture. This has the potential to bring with it inherent risks and there remain some unanswered questions about how these risks will be managed.