North by Northwest: Plans for ‘informal group’ to set ICS agenda

Greater Manchester has begun to articulate how its integrated care system will run, including plans for an informal group of key executives who will ‘ensure coherence’ across its various boards and organisations.

In the most detailed ICS governance proposals NxNW has seen to date, the GM system has laid down plans for a “shared executive group” which would meet every week and set the agenda for both the statutory ICS boards (the NHS board and the wider partnership board).

A paper published on Friday said the ICS’ chief accountable officer would determine the group’s membership, but it would be “more about a fluid group depending on the nature of the work in hand”, as opposed to a formal membership list.

Importantly, it would also link into (and perhaps have members from?) local authorities and the mayors’ office.

The paper said: “The shared executive group function brings together the key executive leaders on a weekly basis under the chairing of the ICS chief accountable officer.

“[It is] not a formal decision-making group, but one that can fulfil the key role of ensuring coherence in the implementation of strategy.

“The group will help steer the implementation process and serve to fix elements or programmes that are under performing.

“[It] sets agenda for board, partnership and committee meetings and commissions papers [and] produces an action note rather than formal minute.”

Many ICSs will struggle with ‘us and them’ dynamics between their two boards (just look at the situation in neighbouring Cheshire and Merseyside).

Working well, the GM shared executive group might be able to create common understanding from the start of an idea, oiling the cogs in what threatens to be a very convoluted and cumbersome system.

But the group’s informal nature could also arouse suspicion that key strings are being pulled, and decisions effectively being made, within a small, closed shop behind the scenes.

It will be interesting to see if this idea survives, and in what form.

In terms of the formal and statutory parts of the ICS, the paper suggests the NHS board would meet officially eight times a year, and the partnership board just four times per year. But a 23-member “joint planning and delivery committee” would also be formed between the two boards, and meet once a month.

The paper does not offer further detail on the contentious issue of funding flows.

New leaders

New guidance from NHS England has confirmed the chair of the ICS NHS board must not be a local councillor, which rules out Sir Richard Leese unless he stands down from Manchester City Council. He can continue as the partnership board chair, however.

So, an advert is now out for an NHS board chair, to be followed by an advert for a chief accountable officer.

The latter appointment feels particularly crucial, and difficult, to get right.

For all his abilities, there was a feeling that Jon Rouse, the nominal ICS’ former chief officer, was never quite accepted by the people who matter in GM, and that someone with more experience of the system — and the personalities in it — might be better equipped.