New rules for ICS boards spark serious concerns

The health and social care secretary has laid an amendment to its Health and Care Bill apparently aiming to limit the involvement of people involved in private healthcare on the boards of integrated care systems. It is due to be debated and probably voted through in the Commons next week, at the bill’s report stage.

The amendment says ICSs’ constitutions “must prohibit a person from appointing someone as a member if they consider that the appointment could reasonably be regarded as undermining the independence of the health service because of the candidate’s involvement with the private healthcare sector or otherwise”.

It is unclear how this will be applied in practice, but the NHS Confederation and Social Enterprise UK have both told HSJ they have serious concerns about it.

Integrated care boards are the part of ICSs which will take over commissioning of NHS services from clinical commissioning groups, and be responsible for much of the executive running of the system, when they are put on a statutory footing, as planned for April.

There has been some controversy about independent healthcare leaders, such as from Virgin Care, sitting on boards of the current non-statutory ICSs, and some campaigners have argued that the reforms will lead to privatisation. However, social enterprises have played a big part in some systems — for example Andrew Burnell, chief executive of City Healthcare Partnership CIC, was the executive lead of Humber, Coast and Vale until last year. 

In September, health minister Edward Argar said the government was “keen to put [concerns about private interest] beyond doubt” by bringing its own amendment. 

NHS Confederation chief executive Matthew Taylor told HSJ the proposed change could damage systems where services are provided by social enterprises, community interest companies and independent and voluntary organisations.

He said: ”We have some concerns that this change could have unintended consequences in systems where key services are provided by social enterprises, community interest companies, independent and voluntary organisations, which we assume will be considered ‘private healthcare’ under this amendment.

“We know that in many systems these types of organisations provide vital community and mental health services and work closely with other system partners.

“This is a key concern for our members, and we would oppose them being excluded under legislation.”

Social Enterprise UK, which represents some organisations providing health and care services, said government “hasn’t thought through” the amendment, and that key providers should be involved.

Its director of health and care Jo Pritchard said ministers should clarify whether the amendment meant social enterprises could not feature on ICBs, adding “we will not have genuine integration without inclusive systems”.

She said: “This amendment has come as a surprise for social enterprises across the country, many of whom have been leading calls for integration and helping to set up integrated care systems.

“Several social enterprises have been proposed to sit on integrated care boards because local leaders recognise their value to their systems.

“We do not believe that the government has thought this through, and it calls into question whether we have the trust and culture to deliver integration health and care systems.

“How can we change local systems to improve population health if social enterprises which have significant expertise and track records of delivery are excluded from the top table? You cannot deliver change without having the key providers in local systems involved in key discussions.

“We will not have genuine integration without inclusive systems where all providers are trusted to be involved in strategy and resource decisions.”

The Department of Health and Social Care was contacted for comment.