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

Most Daily Insight readers’ appetite for hearing about the prospective deconstruction of integrated care systems – six months before they are due to be created in law – is probably low. The same could be said for the parliamentarians spending hours in committee discussions right now putting them into statute.

But under some discussions taking place, which some would like to see develop, ICSs would pass most of their important responsibilities over to provider collaboratives or groups, and then – perhaps – wilt away altogether.

Penny Dash, chair of North West London integrated care system and previously a top McKinsey consultant recounted some of these discussions at a recent event, while Sir David Dalton, currently interim chief of Liverpool University Hospitals Foundation Trust, said he thought ICSs beginning to pass key responsibilities to provider collaboratives would be a good development.

Both have stressed, as our article about their comments at a recent event records, that structural reorganisation and new organisational blueprints are unlikely to achieve a great deal.

It also seems unlikely, considering how new organisations tend to behave, that ICSs will be desperate to hold back their ambitions, and get right in the queue for abolition, nor that policy makers will be keen to scrap their latest creations.

That said, there is genuine discomfort out there, especially in provider-land, about the new ICS set-up, with a complex jungle of competing decision-makers surrounding it, and whether it will really streamline anything. This streamlining of decisions – for many – was the whole point of escaping the Lansley structures in the first place.

Like it or not, the flaws of each re-disorganisation – whatever they turn out to be – create the seeds of the next. Although a full-on dismantling of ICSs, and losing the purchaser side altogether from the NHS, is not on the cards, it is entirely possible that more systems will follow (voluntarily or otherwise) in the path of some in the North of England and merge to cover populations in the region of three million, delegating much more out to provider groups and boroughs, counties and districts.

Claws out for the pussyfooters

NHS England leaders clearly have a lot of things on their plate but perhaps few were ready for what the lead of its workforce race equality standard had to say.

Anton Emmanuel told an open conference recently that the organisation was “pussyfooting” around the release of its new, long-term race equality strategy amid a “media storm around ‘wokery’”.

Striking comments to make. He also urged NHSE leaders to “show more courage” in the wake of negative media headlines in recent months.

Speaking at a conference held by the British Association of Physicians of Indian Origin, he said: “If you really believe there is a way of making a difference, and you believe that leaders want to be accountable for their actions, we as [ethnic minority] people – I’m half-African, half-Asian – have to believe that there are leaders who want to do that.”

For some in the press, this will come as a moral victory in the so-called “war on woke”.

If their coverage is apparently generating this sort of response from NHSE officials then it could embolden them to keep going.

However, the fact Professor Emmanuel said this will prompt serious discussions internally.

Corrected on 2 November 2021 to make clear that the possibility of ICSs handing over their roles to provider collaboratives was not a “vision” supported by Penny Dash, but one she was recounting from others.