Agenda item

To consider any requests received in accordance with Part 4, Section B, paragraph 29 of the Council’s constitution.

The Chair noted that a deputation had been received from NCL NHS Watch on Integrated Care Systems (ICS).

Brenda Allan, NCL NHS Watch, explained that she had addressed the Committee before in relation to ICS and that a white paper, Integration and innovation: working together to improve health and social care, had now been published.

She noted that there had not been a lot of consultation but that the proposals were far reaching and would amalgamate local authority and NHS assets and services. It was acknowledged that the stated goals in the white paper were laudable but that there was a significant lack of detail in relation to the proposed positions, context, and practical arrangements.

NCL NHS Watch had concerns that the proposals would result in an unequal partnership with a lack of democratic accountability. It was stated that the letter accompanying the white paper noted that the composition of the proposed NHS Board would need to support effective decision making; it was felt that this would lead to limited representation on the main, decision making body and that not all parties would be equal partners. Although there were borough based partnerships, it was felt that these would be NHS dominated and that there would be no new funding for local authorities.

Brenda Allen, NCL NHS Watch, noted that there were concerns relating to social care, public health, and local democracy. It was stated that the current crisis in social care was not acknowledged in the white paper and it was felt that public health had not been prioritised. It was commented that the proposals would reduce the role of local government and that this would limit the ability for the full integration of health and social care. It was added that NCL NHS Watch had not been reassured by the NHS England responses to concerns raised about digital and remote consultations. It was considered that public health issues were not easily addressed by ICS and that key services addressing inequalities had been cut back by local authorities. It was stated that Joint Strategic Needs Assessments and ongoing public health work recognised the importance of addressing inequalities but that political will and funding also was required.

It was stated that there should be further consideration of how the ICS framework could be used to produce something more collaborative which genuinely involved local authorities and the public. It was suggested that further consultation was required and that the implementation of the proposals should not be rushed. In particular, NCL NHS Watch noted that further detail was required in relation to parity of representation and voting rights, how ICS would be accountable particularly where local authority services were involved, the balance of digital and in-person provision, and the role of independent providers in relation to resource allocation.

In response to a question about the importance of localised services and tackling health inequalities, Brenda Allen stated that the NHS was largely a curative organisation and that, in order to tackle inequalities, joint working with other organisations and services, such as housing and benefits, was key. She commented that the proposed structures were health dominated, that a public health approach required wider involvement, and that local authorities would have limited input on the allocation of resources. It was stated that there had been budget cuts to council services in recent years and it was not anticipated that an NHS body with no additional funding would be able to deliver significant improvements.

Some members of the Committee noted that, traditionally, the NHS did not have the same level of democratic oversight as care and it was difficult to integrate the governance of these two systems. It was added that there were references to ICS being less bureaucratic but that the proposals included multiple committees and forums and it was not clear whether ICS would be able to achieve the objectives that had been set. Professor Sue Richards, NCL NHS Watch, explained that the Health and Social Care Act 2012 localised decision making about health and operations but that there was now a pressure to centralise, first through the mercer of the five North Central London (NCL) CCGs and now through ICS; she stated that this was not grounded in local democracy and that the role of local authorities would be reduced, particularly in the case of social care. Alan Morton, NCL NHS Watch, added that there were also concerns about increased centralisation in relation to financial control as there was likely to be more outsourcing to external companies to provide advice for issues such as digitisation and organisational change.

In response to a question about the role of independent providers in decision making and resource allocation, Brenda Allen, NCL NHS Watch, believed that there was already some conflict of interest where GPs were members of CCG boards but that this would increase under the white paper proposals. She stated that, although there were a number of boards, the ICS NHS Board would make the key decisions. This board would have a tightly controlled membership which could include independent providers; she felt that this would result in an inherent conflict of interest which would be contrary to good governance.

The Chair thanked NCL NHS Watch for the deputation and noted that the issues raised would be considered by the Committee.