• Midlands NHS system accused of “largely excluding” councils’ leaders from plans
  • Council chief says NHS cannot explain what an ICS is
  • Local authorities say current governance not “fit for purpose”
  • Background of NHS/council tensions on patch

Two councils have accused their local NHS of failing to involve them in its system planning, and complained about how an integrated care system is being developed.

A joint letter from senior figures in Leicestershire County Council and Leicester City Council to their local sustainability and transformation partnership leadership this week said: “Our executive members have been largely excluded from the development of local transformation plans.

“This is a concern, as from their inception, these transformation plans were expected to provide a view of health improvement beyond that of the NHS.”

It comes as STPs and ICSs are required to imminently submit their final five-year system plans, setting out how they plan to implement the NHS long-term plan.

The councils’ letter, shared with HSJ, complained that “strengthening collaborative relationships and trust… has not happened here so far”.

Dated 29 October and signed by the city mayor and deputy, and county council leader and cabinet lead, the letter said the ICS needed to find a “partnership model that is fit for purpose if there is a need for joint decision making”, and that an existing “partnership group is consultative and does not fulfil this”.

A history of tension

It is not the first example of strained NHS/local government relationships in the area. Both councils were irritated by proposals to develop an “accountable care system” in 2017, and there have been tensions over proposals for acute and community hospital reconfiguration.

There have also been fallouts within the NHS over attempts to combine clinical commissioning group leadership and merge the groups, as well as tensions between local government and NHS leadership in several areas since the STP process began in 2016.

A separate letter from Leicestershire County Council chief executive John Sinnott was sent to the area’s interim STP leader and Leicester City CCG managing director, Sue Lock, on 30 October — this responded to her reply to earlier concerns about the NHS’ approach which that council had set out in September.

Mr Sinnott’s latest letter said the ICS was “a concept [and] it is hard to see how it has any organisational form and therefore what functions and authorities it has”.

He was concerned that, without a joint NHS/local authority decision-making body, the “NHS in [Leicestershire, Leicester and Rutland] is claiming progress on its ICS ‘journey’ and assuming unquestioning local authority partner support”.

Mr Sinnott said: “Thank you for your letter… unfortunately, it does not answer the fundamental question of what is an integrated care system.”

Both council letters also expressed concerns there had been a “misunderstanding” in the NHS that existing health and wellbeing boards or overview and scrutiny committees could be a basis for “systemwide decision making”, which the councils say they cannot.

Framework

NHS England and Improvement’s implementation framework for the NHS long-term plan, published in the summer, required ICS to set up a partnership board “drawn from and representing commissioners, trusts, [and] primary care networks”. It recognised it could not compel local authorities to participate but said there was a “clear expectation” that they would.

The framework also said that, as a minimum, primary and community care elements of the ICS system plan should be “subject to dedicated discussion at all health and wellbeing boards”.

In the letters from councils, and reply from Ms Lock, all indicated they wanted to continue to work together. Mr Sinnott’s letter proposed that, once the latest five-year plan had been approved, it could be “submitted” to local authorities for “information and comment, where particular attention would be doubtless paid to affordability and priority of proposals”.

Ms Lock said: “It is welcomed that Leicestershire [CC] has reiterated its commitment to supporting the integration of health and care services wherever possible… We are also pleased to note that the county council officers will continue to take part in various groups that support this work.”

Sandwell and West Birmingham CCG chief officer Andy Williams will take up the role of joint chief executive of the Leicestershire, Leicester and Rutland CCGs, and leader of the STP, later in November. The three LLR CCGs are still considering whether to merge.

The STP has been approached for comment. Leicester City CCG declined to comment on the story.