Michael Rourke on what the new ICS Boards and Health Partnership Boards will look like

As we await publication of the new Health and Social Care Bill the “devil in the detail” remains unclear.

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What the new ICS Boards and Health Partnership Boards will look like, and how they might direct, advise or control the trusts at the coal face remains a key “known unknown”, as the former US defence secretary Donald Rumsfeld famously referred to in 2002. The Health and Social Care Committee’s First Report of Session 2021–22 noted that the statutory changes to improve integrated working “received a positive response from a wide range of organisations and stakeholder bodies”. However, this support was “caveated with concerns about omissions in the White Paper and areas that required further detail”.

Integral to bringing about improvements is the new duty to promote collaboration. What a broad statutory duty to collaborate means in practice is still to be addressed. Indeed, the White Paper provides a number of instances where “guidance” will, or may, follow:

  • What collaboration should look like
  • Making joint appointments
  • Creating new NHS trusts
  • The intervention power for the secretary of state for service reconfigurations and the replacement of the Independent Reconfiguration Panel
  • How ICS health and care partnerships can be used to align operating practices and culture

The White Paper also provides for an “appropriate intervention power” for the secretary of state in the working of NHS England, although how and when this may be invoked remain unclear.

The current “known unknowns” may not resolve when the Bill is published, with many of the “how will this work?” questions being left either to future guidance, or for ICSs to develop.

The Health Committee’s Report of 14 May set out that those who gave evidence to the committee thought that “the success of the new bodies would be dependent on the Bill setting out in detail how they would work together, their powers and the composition of their boards.” The committee made a recommendation to this effect. It is unclear whether the Bill will be so prescriptive, or adopt a more permissive model. A key “known unknown” is whether the different approaches adopted at ICS level will have implications when set against national directives or requirements.

For example, the single ICS waiting list, cited by Amanda Pritchard as being a key benefit of the new systems: How a single waiting list can be managed at system level, where decisions for system benefit may adversely affect individual NHS performers, and how to square the circles of individual provider responsibilities (which are to remain statutory) with this new duty to collaborate and practical matters such as this remains a “known unknown”.

It is clear that the April 2022 timeframe for implementation means there will inevitably be a few as yet “unknown unknowns” to be resolved, in addition to the “known unknowns”. Hempsons will be producing more guidance on our Health and Care Bill Board as soon as we know more. Watch that space…