Agenda item

To receive an update on Integrated Care Systems (ICS). (To follow)

Presenting Officers

-       Frances O’Callaghan: Accountable Officer for North Central London CCGs.

-       Richard Dale: Executive Director of Transition at North Central London CCG – North London Partners)

Frances provided an overview of the report and highlighted the benefits for residents of the new integrated care systems (ICS). She explained how the ICS would take on responsibilities which previously sat under the CCG and would be placed based. The new set up would enable continued engagement with residents and the ability to respond to their needs, which had changed following the pandemic. The Integrated Care Board (ICB) would be established to work with Local Authorities to understand the place-based partnerships arrangements and how the ICS could best deliver these.

Richard explained that the primary aim of the ICS was to streamline work and reduce unnecessary bureaucracy, as well as enabling funding to be moved around in a way that it previously had not been able to. It was noted that in response to the pandemic the system had already been acting as an ICS, helping to meet the community needs, for example having implemented new ways of providing care at home, introducing new technology to provide higher level of support and greater involvement within communities to ensure neighbourhood borough care was in place. Richard said clinicians would remain at the heart of the system, but services would be designed around local people.

Councillor Clarke asked whether the committees would continue to be open to the public. Richard advised that the bill had not been finalised yet, but that Local Authority involvement would remain key. The understanding was that the ICB would have a single Local Authority member on it, but specific arrangements were still being worked through. Frances said that Local Authority involvement would remain a key aspect of the ICS, as the group needed to understand how accountability for spend would take place collectively. She assured the committee that there was a commitment to collaborative working, which had already been evidenced over the previous 18 months.

Councillor Clarke asked if officers had received the seven recommendations put forward by the JHOSC. Frances confirmed that the recommendations had been read and that she envisaged there would be no change in terms of the role and engagement with the JHOSC moving forward. However, due to the bill not being confirmed, officers were unable to provide specific detail on arrangements, but acknowledged that to provide the best services for residents, scrutiny would continue to be a key element.

The Chairman questioned the decision to only have one Local Authority representative for all five boroughs on the ICS and felt that this individual would require extra support to understand the needs of each borough. Frances advised that the NCL Partnership Council would have all five Local Authority Chief Executives on it, which would feed into the ICB. It was also noted that once the CEO for the ICB had been appointed, arrangements to support the Local Authority representative on the ICB would be discussed. Officers emphasised that there would continue to be important links with Directors of Public Health and Adults, as well as several forums connected to the ICB to ensure close partnership working with Local Authorities. Members asked if an internal review would take place at an appropriate time, officers agreed that a review point was good practice and that discussions with the CEO and partners around this would take place.

Members queried whether the re-structure had resulted in any jobs loses for CCG staff, it was confirmed that no jobs had been lost as part of the process. Members also asked for clarity on whether private providers would be invited to sit on the board, it was noted that it was not envisaged that any private providers would be included.

Councillor Levy raised concerns about significant preparation work having taken place before the bill had been agreed. He also felt that in the past transformations had become top down heavy and not structured in a way to best serve residents. Councillor Levy stressed the role of Members to represent their constituents and ensure they received the best care, which meant it was crucial that they were properly engaged. He expressed the view that at least two Local Authority representatives would be required on the ICB, to provide contingency if one member was unable to attend. The Chairman emphasised that the committee was looking for confidence in the new system and to see evidence that services would be truly joined up, as well as opportunities being embedded for Members to raise their voices on behalf of residents, provide scrutiny, and be heard.

Members asked if all seven recommendations put forward by the committee at the last meeting had been received by officers. Officers confirmed that these had been read and would be considered, however they were unable to provide any certainty until after the bill had been passed. Councillor Clarke requested that recommendation 7 of the JHOSC be strengthened. The seven recommendations put forward were as follows:

1.    The Integrated Care System (ICS) and its committees should be as open to the public as possible.

2.    The NHS ICS Board should include local authority representation, local authority voting rights, and the ability to discuss and challenge decisions. It should also ensure that all agendas, minutes, and relevant documents are open to the public. It was considered that this would ensure transparency and accountability.

3.    The role of the Joint Health Overview and Scrutiny Committee (JHOSC) should be maintained, including the ability to scrutinise all decisions made by the ICS. It was also considered that the JHOSC should retain the right of refer matters to the Secretary of State.

4.    The ICS should consider how patient and resident voices would be included in its processes. The JHOSC felt that patient and resident voices should be included at all levels, including the top level.

5.    The JHOSC also requested further detail on the arrangements for the NHS ICS Board, the governance and committee structure within the ICS, and the relationship between the different committees, and how the voices of patients and residents would be included.

6.    The ICS should have an identified committee that was aware of any business relationships between primary, secondary, and tertiary providers to ensure openness and transparency.

7.    To support the NCL NHS Watch recommendation.

The Chairman requested that an update on the complex financial arrangements be included within the next report, to enable Members to understand how the joint budgets would be shared across Local Authorities and the NHS, as well as the governance arrangements surrounding this. Officers agreed to provide this within a report to be brought back in January 2022.

RESOLVED that the Committee noted the contents of the report.