Campaigners struggling to follow decision-making and policy proposals in the giant North East and North Cumbria Integrated Care System (NENC ICS) have written to the principal NHS leaders in the area to express their concerns at the loss of local democratic accountability since July 2022, when 42 “Integrated Care Systems” took over responsibility for health commissioning across England.
They are keen to see their challenge to the current set-up publicised, and where possible echoed, by local campaigners up against massive obstacles to democratic accountability in other areas of England.
The “Integrated Care Systems” created by the 2022 Health and Care Act have a multi-layering of roles and functions and, as such, have a complexity of Boards and Committees.
In the north, within the NENC ICS there are three levels of operation and decision-making:
- The Integrated Care Board is the body that takes decisions over commissioning and but also sets budgets and targets for providers (NHS trusts and GP services) and must work with local government across the whole of the ICS area, coast to coast (the largest ICS in England)
- The ICS is sub-divided into four Integrated Care Partnerships (ICPs) – North, Central, South and North Cumbria. ICPs are jointly convened by Local Authorities and the NHS, comprised of a broad alliance of organisations and other representatives, which are supposed to work as “equal partners concerned with improving the health, public health and social care services provided to their population.” The four NENC ICPs meet independently in their localities. There is also a Strategic Integrated Care Partnership meeting and Board, which is made up of reps from the four areas – this Strategic ICP meets twice per year.
- Each of the four ICPs are further sub-divided into place-based teams. These follow 14 local authority boundaries / the previous CCG areas.
However none of this has been properly opened up to the public in the north of England, and Keep Our NHS Public North East, Save South Tyneside Hospital Campaign and KONP Sunderland joined forces on November 25 to forward a jointly-written open letter to NENC ICB which focuses on openness, transparency and collaboration regarding decision-making at local sub-committees and Board meetings.
All three North East Campaign groups are increasingly concerned regarding hurdles to public access and involvement, the reduction in local democracy and restricted access to papers and information that have made it harder to hold NHS bodies to account under the new system.
The letter is addressed to Claire Riley, the ICS “Executive Director of Corporate Governance, Communications and Involvement,” and copied to the ICB leaders, the four ICP chairs, local Healthwatch officials and Victoria Atkins, Secretary of State for Health and Social Care.
The letter notes the limited involvement of elected councillors on the ICB Board, “and a very real danger that local voices will not be heard at the ICB at this top level.” It argues that that more could be co-opted.
It goes on to highlight the inaccessible location of most ICB meetings, at a venue on an industrial estate 2.5 miles away from Durham city centre. “Given the huge geographical footprint of the ICS, we recommend some consideration be given to arranging a more accessible location, ideally near a transport interchange served by train, bus, metro and with nearby parking. … a location (for example) by Newcastle Central Station would seem to be a more obviously accessible choice.”
Another problem is the restrictive requirement that any questions to the Board must be based on the agenda – and therefore cannot be prepared before the agenda is published – or point out where issues have not been properly discussed.
And since questions must be received three working days before the Board meeting is held, the late publication of agendas makes this almost impossible: only one of the last six NENC ICB agendas was published with even the minimal three days before the meeting. With the ICB only meeting every 2 months, and questions relegated to the very end of the agenda this arrangement gives little or no chance to question the Board. The campaigners urge the ICB to offer an option to ask a question in person, and a right to reply.
There is an option for the Integrated Care Partnership meetings to be held in public. However that is simply a form of words. In practice:
“Currently, the ICP Area meetings are not held in public and there is no public access to the agenda, minutes or reports. There is, thus, no process in place for a member of the public to put a question directly to the Area ICP meeting relating to healthcare provision in their own region. This important channel of communication must be opened.”
On place-based teams the situation is even worse: “The specific activity of the local place-based teams remains unknown to the public. The ICS has stated that “the place-based subcommittees are not meetings held in public, however minutes from these meetings are submitted to the ICB’s Executive Committee monthly for assurance purposes.”
But for place-based decision making to be in any way accountable, the campaigners argue, the minutes of the place-based sub-committees should be in the public domain. Decision-making regarding commissioning and procurement – the future of our healthcare – is taking place within the place-based and ICP teams, and this needs to be transparent.
Without these changes to the way it conducts itself, there is no way the stated commitment of the ICS to “put the voices of people and communities at the centre of decision-making and governance, at every level of the ICS” and to “provide clear and accessible public information about vision, plans and progress, to build understanding and trust” can be delivered.
It’s likely that similar problems are being encountered in many if not all of the 42 ICBs, and it’s only by publicly raising these issues that NHS bosses can be shamed into making the simple changes that would at least offer a degree of accountability and allow campaigners and the wider public to keep up to date with changes and plans that affect the health care of whole communities.
It’s conspicuous that Healthwatch, which is supposedly the local body to represent the needs and views of the wider public, are having to be treated in the same way as the senior management, and urged to stand up for a more democratic approach.
The full text of the letter is available at https://konpnortheast.com/ics/ (scroll to part 7).
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