The must-read stories and debate in health policy and leadership.

Our editor Alastair McLellan called on Bob Dylan to help paint a picture of the dilemmas surrounding the creation of integrated care systems: “He not busy being born is busy dying.”

ICSs are still due to be formally created in law on 1 July (see below). But under a mantra of devolution and subsidiarity they are tying themselves up in knots – passing on their responsibilities to a jungle of committees, partnerships and provider collaboratives – with a lot of local variation among them.

Our leader advises the centre should “suspend the current mantra which is requiring ICSs to rapidly delegate most of their responsibilities and budget” and instead “get behind ICSs in their first year”.

It goes on: “In parallel, government and NHSE should reconsider why such a plethora of different governance arrangements are springing up around the country and ask how that will really help with successful service change and – yes – real integration, in the years to come.”

Being born

This week in Parliament should – if all goes to plan – see the final throes of the legislative action to finally turn ICSs into a formal accountable body.

The Health and Care Bill was up in the Commons last night. The government made a concession to the health and care lobby (and to the Lords) by watering down the powers it is taking to intervene in NHS reconfigurations.

Ministers are however – at the behest of the Treasury – still resisting a move to force more transparent, regular workforce planning; and another to make the cap on care costs more fair to those with less money.

The bill will ping-pong back to the Lords today (Tuesday), with an expectation they will now let it pass unchanged before the Parliamentary session is prorogued on Thursday.

That’s not a given – peers could turn up and vote again to overturn the government on workforce and the care cap.

But if they let it pass, it will give enough time for royal assent, and for the ICSs to be created in law on 1 July – then to find out if they are still being born, or starting to die.