John Lister comments –

Never has there been a clearer argument for the proper integration of NHS services and integration of NHS with local government services than the current Covid-19 pandemic.

Yet there is precious little evidence that changes that are being passed off by NHS England as “integration” are anything more than a flimsily concealed drive for greater centralisation and reduced local accountability.

In the aftermath of recent revelations in the Lowdown and the HSJ of plans by NHS England’s regional office to impose a ‘fundamental’ overhaul of the NHS in the capital, Greater London Assembly member Onkar Sahota has written to the mayor of London to express his concern over  “the seemingly advanced stage of planning” for a new system “without any documents being released, let alone consultation with Londoners”.

And recent analysis in the HSJ suggests that NHS England is taking advantage of the current situation (and the lockdown) to drive forward with its restructuring:

“turbo-charging some of the key structural changes and integration which were envisioned, and towards which the NHS had been trying to drag itself for several years.”

For several years the rhetoric of NHS England has echoed with references to integration, more recently the establishment of “Integrated Care Systems,” (ICSs) which according to the Long Term Plan are supposed to cover the whole of England by 2021 – despite the fact that they still lack any statutory powers or legitimacy.

On May 11 NHS England declared it was beginning to “lock in” changes that had been pushed through as part of emergency measures to cope with coronavirus:

“The NHS and its partners will be able to ‘lock in’ improvements to their work by putting whole-system planning at the heart of coronavirus recovery plans, the NHS’s Chief Operating Officer said today.”

The same statement revealed NHS England and NHS Improvement have rubber stamped four new ‘integrated care systems’, “together serving more than six million residents.”

The new ICSs, which join 14 previously announced and two ‘devolved health systems’ in Greater Manchester and Surrey, are Humber, Coast and Vale;  South West London; Sussex and Hertfordshire and West Essex. As a result “around half of England’s population” is now covered by an ICS, including the whole of Yorkshire and all of London south of the river.

Many of these changes, accompanied by widespread mergers of local Clinical Commissioning Groups to create ever-larger and less locally responsive organisations holding the purse strings for NHS services (in line with the call by NHS England for there to be normally just one CCG per ICS) have been made with little or no engagement with local people.

Moreover we should not underestimate the extent to which they are also simply blather and bluster to conceal little or no actual integration or cooperation at local level.

All of the examples of partnership working quoted by NHS England last month, far from making the case for ICSs, in fact show that wide-ranging collaborative initiatives can be and have been carried through successfully prior to, and without establishing an ICS.

  • a vascular services network involving hospitals in Hertfordshire and West Essex;
  • helping to train and recruit more than 300 advanced clinical practitioners, nursing associates and physician associates in Humber, Coast and Vale;
  • improved mental health support for around 80,000 school and FE college pupils in South West London;
  • and “improved performance against the national A&E four-hour target by 1.2 per cent during 2018-19” in Sussex.

NHS England also claims in the same press release that Integrated care systems (ICSs) and, in other areas, sustainability and transformation partnerships “have been central to the coordination and delivery of the response to the Covid-19 epidemic, bringing together hospitals, care homes, GPs and others to plan for immediate and future needs.”

But there is little or no evidence from the ICS websites linked to these claims that the ICSs have played any role at all in these developments, which have taken place across the country whether or not an ICS has been in place.

Indeed there are few signs of life  at all on many of the ICS websites, some of which – despite prominent tabs misleadingly labelled “Get Involved” – have no entries more recent than summer 2019. Most ICS websites also consistently show that the involvement of local government is either non-existent, or a token add-on to other collaboration between NHS organisations.

In South Yorkshire and Bassetlaw, for example, the ICS website describes a “System Health Oversight Board”, as “a joint forum between Executives and Non-Executives from NHS England, NHS Improvement, other national arms’ length bodies and health providers, health commissioners.”

It also refers to a “System Health Executive Group – a monthly meeting of Chief Executives, Accountable Officers and other health partners”.

And then it adds:

“We also continue to work with our Local Authority partners to inform and shape how our system health and care partnership arrangements might be organised.”

The Lowdown’s fearless investigators have tirelessly trawled through all of the websites for the 18 ICSs, to find only a small minority showing any kind of life, or any pretence of transparency or public accountability. If NHS England is, as the HSJ suggests “turbo-charging” its progress towards a full roll-out of ICSs, this is being done without any process of public engagement, and behind a veil of largely dormant and irrelevant websites.

In a way of course this is preparing the public for the level of accountability that is likely to prevail when the full network of ICSs, still lacking any legal status or legitimacy, takes over control in all 42 “footprints” across the country next spring, removing all of the key discussions and decisions about the future of local services from public view.

Meanwhile local council scrutiny bodies, many of which have remained locked down weeks after local commissioners, NHS England Regional directorates and other NHS bodies have begun to meet online and push forward with their agenda, need to step up their game if they are to stand any chance of holding local NHS chiefs to account.









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