• Nursing, finance and medical directors required, plus chief and chair, required for ICS NHS body
  • Trusts, GPs and local authority will have ‘seat on the board’
  • Ducks question of appointment process 

NHS England has set out who will be required to be on the NHS board of each integration care system.

Guidance published this afternoon – ahead of draft legislation due in coming weeks – requires at least 10 mandatory members for “ICS NHS body” boards. The minimum required board members include:

  • Four executives – the chief executive and finance, nursing and medical directors.
  • Three independent non-executives: a chair and at least two others. They “will normally not hold positions or offices in other health and care organisations within the ICS footprint”.
  • Three “partner members”: one from an NHS trust/foundation trust in the patch, one from general practice, and one from a local authority. They will “not be acting as delegates of those sectors”, however.

Beyond this the rules are quite flexible. Systems can add more ICS NHS body board members to suit their needs - but these are subject to approval by NHS England and boards should be “an appropriate size to allow effective decision making to take place”, according to the design framework.

It stresses that decisions should be reached by “consensus”, with a vote “considered a last resort”. The chair can make decisions if there is disagreement, or the ICS could “draw on” NHS England mediation.

NHS ICS boards will be the decision makers on NHS finances and services, but will “have regard to” strategies which will be drawn up by separate “ICS partnership” boards (see below).

Senior appointments

The guidance says formal “designate” ICS chairs and chief executives must in place by end of September this year, but it ducks the controversial topic of how they will be appointed, pointing only to a not-yet-published “agreed national recruitment and selection processes [and] guidance on competencies and job descriptions issued by NHS England and NHS Improvement”.

Issues of controversy on this include how much say the health and social care secretary has over appointments; and which roles will be openly recruited, rather than filled with incumbent ICS leaders — which also has a bearing on leaders’ redundancy terms.

By the end of 2021 the other executive board roles must all also be confirmed, and the ICS NHS bodies and ICS Partnerships must be ready to operate in shadow form.

In the document NHS England commits to providing further guidance on “manage conflicting roles and interests of board members”: A provider chief who sits on the ICS board will remains accountable for their own organisations’ performance, as well as having a formal say in ICS decisions.

Other roles

Rules for ICS Partnership boards will be published separately by government. But today’s guidance indicates they must have a chair jointly selected by the ICS NHS body and local authorities; and said “some systems will prefer the Partnership and ICS NHS body to have separate chairs”.

The paper says the partnership will act like a “forum” and operate under consensus agreement decision making.

Further guidance is expected on provider collaboratives in coming months, though the document said ICS could “contract with and pay providers within a collaborative individually” or contract with a lead provider on behalf of a collaborative”. it said the ICS NHS board and chief executive “will be ultimately responsible for services under delegation arrangements with place-based partnerships or through lead provider contracts.”

A large range of possible mechanisms are laid out for establishing “place” based decision making — but NHS ICS boards will be ultimately responsible for their use of resources.

Speaking about the publication, NHSE deputy chief Amanda Pritchard said: ”The creation of statutory ICSs is an opportunity to build on the collaborative working that has been a key feature of our pandemic response and will continue to be so as we restore services and get on with improving the health of our local communities.

“To help leaders prepare, we have produced this framework through close collaboration with ICS leaders, the full range of NHS organisations, patient groups, clinical and professional leaders, local government and the voluntary sector. It seeks to provide clarity about the direction of travel and areas where consistency will be important, while allowing local flexibility to design systems in a way that will be most effective within each ICS.”

HSJ Integrated Care Summit

The 2021 HSJ Integrated Care Summit will take place in Manchester on 23 – 24 September, uniting senior leaders across the healthcare system to collaborate across their STPs/ICSs and work towards the national integrated care vision.

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