Agenda item

The seminar session will focus on discussions around the Integrated Care System (ICS) consultation, submissions, and recommendations.

Rachel Lissauer, CCG Director of Integration, introduced the item and noted that it was aimed to involve the Board in discussions about the next steps for Integrated Care Systems (ICS). It was explained that NHS England and NHS Improvement had produced a paper, titled 'Integrating Care', which set out a renewed ambition for greater collaboration between partners in health and care systems and this put forward options for a legislative basis for ICS. Option 1 would provide a statutory ICS Board/ Joint Committee with an Accountable Officer where NHS commissioners, providers, and local authorities would take collective decisions. Option 2 would provide a statutory ICS Body which would be established as an NHS body by 're-purposing' Clinical Commissioning Groups (CCGs), would take on commissioning functions, and would have locally defined frameworks and functions. In either case, it was anticipated that the new statutory basis would be established by April 2022.

In practice, it was expected that each ICS would lead on prevention, joining up care, access to digital services, acting as a major employer, and as an estate owner; there would also be meaningful, local, delegated budgets. It was highlighted that the proposals were not prescriptive about the framework to be used at borough level but it was anticipated that there would be partnership working, with a key role for local authorities. It was explained that the role of the ICS would be to distribute financial resources, target resources to areas with greater need, and to tackle inequalities. It was anticipated that commissioning would be strategic and there would be a single source of funding. It was noted that the proposals did not provide a detailed definition of the arrangements at ICS and borough level but noted that there needed to be a balance between the two and that the arrangements should include resident voices. It was explained that the CCG Governing Board had supported Option 2 and considered that it would be helpful to proceed at pace. It was acknowledged that the proposals would abolish the CCG but it was highlighted that the expertise and progress made in the existing arrangements would be retained. It was acknowledged that the Board had identified that further work was required in relation to public accountability and it would be helpful to receive further detail about this.

Beverley Tarka, Director of Adults and Health, noted that the Council welcomed the overall approach but that more clarity was needed to ensure that local arrangements would include health and care representatives and the community. It was considered that resident and patient involvement should have more primacy, that there should be a stronger reference to the voluntary sector, and that there could be more of an emphasis on the more expansive roles that councils needed to play. It was noted that the proposals did not include any references to the roles of Health and Wellbeing Boards or other partners and groups and it would be important to understand how these groups could provide input to improve health outcomes. It was added that Haringey had recently introduced a Community Health Advisory Board which fed into the Health and Wellbeing Board to ensure that resident voices were included and the Council wanted the ICS proposals to be clearer about the mechanisms for local engagement.

The Director of Adults and Health summarised that the Council supported the Local Government Association (LGA) response which highlighted that local authorities and partners worked alongside the NHS to effect change, reduce health inequalities, and improve health outcomes. It was noted that the consultation was at an early stage and that contributions from the Health and Wellbeing Board were welcomed in order to build on the framework of responses.

In response to a question about timescales, it was confirmed that the national consultation had been released in November 2020 and had closed on 8 January 2021. It was noted that this was an early paper and that there would be some opportunities for continued contributions. It was added that the projected endpoint was April 2022 and it was aimed to have a new statutory basis for ICS at this point.

Sharon Grant, Healthwatch Chair, noted that there were concerns from the patient and public engagement point of view, that the proposals did not have much detail about what would happen to existing duties and powers which had been long fought for. It was noted that there were some innovative initiatives that had been developed to improve health locally and it would be important that the new structure did not preclude these opportunities. It was commented that the proposals seemed to be centralising arrangements when people were generally in support of increased localisation.

Dr Peter Christian, NCL CCG Board Member, stated that he was cautiously optimistic about the proposals. In the existing arrangements, he explained that it had been unrealistic to create a competitive marketplace for health and he felt that the new arrangements might be a fairer and more equitable model for a local healthcare system. The CCG Director of Integration acknowledged the important duties and powers of Healthwatch and other organisations in holding local healthcare arrangements to account. It was noted that the CCG was working towards a transition that would be as inclusive and carefully planned as possible. It was added that effective partnership working had strongly progressed during the response to the Covid-19 pandemic and it would be a good time to maintain these ways of working. The Director of Adults and Health also noted that Haringey had always sought to include local views and this would be an important basis for any local health arrangements.

Geoffrey Ocen, Bridge Renewal Trust, enquired whether other areas across the country had generally supported Option 1 or Option 2 and noted that the balance between local and national decision making would be very important. The Director of Adults and Health explained that the consultation had closed recently; it was confirmed that there would be a national decision, rather than different options for different areas, but there was no indication as yet in relation to which option was more popular nationally. It was added that further information would be available in future but that the Covid-19 pandemic had highlighted the importance of joint working. The CCG Director of Integration also noted that, although there would be a national framework, it was envisaged that each local area would be able to develop their arrangements with local variations. Charlotte Pomery, Assistant Director of Commissioning, noted that it would be really important to ensure the continued involvement of residents in local health and care.

Sharon Grant, Healthwatch Chair, asked how other councils in NCL were responding to the consultation. The Director of Adults and Health explained that there were regular meetings between NCL Directors of Adults and Social Services and there was a general consensus which echoed the points raised by Haringey Council. It was noted that it would be important to articulate what the local area wanted to be developed and NCL Directors were working to articulate this.

The Chair noted that she had met with other lead members in NCL, discussed some key governance and resourcing questions in relation to the proposals, and submitted an initial response to the consultation in December 2020. There were some concerns about how the proposals would ensure that community voices were genuinely included and how they would focus on reducing inequality and social exclusion to improve health outcomes. It was noted that these discussions had brought forward some important points and that the Health and Wellbeing Board would welcome future updates, particularly following the outcome of the national consultation and proposed next steps.