The 42 Integrated Care Boards (ICBs) across England that are responsible for planning, commissioning, and funding NHS services also have a legal duty to involve people in their area in these processes.
The Health and Care Act 2022 states that citizens, their carers and representatives have the right to be involved in the planning of healthcare services, the development and consideration of proposals for changes in how those services are provided, and in decisions affecting the operation of those services.
But just how easy is it for a member of the public to get involved with the work the ICB does?
Can an individual member of the public question plans or raise objections to plans devised by the ICB?
First a quick look at the make-up of ICBs and who must be represented on the board.
Make up of the ICB
Each board must fulfil requirements set by the Health and Care Act 2022 and NHS England guidance and have at least 10 members that include the following:
- a chair and chief executive
- a director of finance, medical director and director of nursing
- at least two non-executive members
- at least three ‘partner’ members to bring ‘knowledge and a perspective from their sectors’, nominated by NHS trusts, primary medical services and local authorities in each ICB area respectively
- one member should bring knowledge of mental health services
- no board member should be appointed if their involvement in the private health care sector would impact on their role.
There is no obligation to have an expert in public health or social care on the board, however, there will always be at least one and maybe more representatives from a local authority, and this can often cover public health and social care.
It should be noted, however, that the ICB does not have to have a member representing people who work in the NHS, such as a trade union representative, or a member representing patients and the public, such as a member of Healthwatch or from a community organisation.
However, outside of the board of ten, more members can be recruited, and the guidance on membership is flexible, so it could include trade unionists and organisations representing patients should the ICB wish. Additional members often include public health experts, directors of adult social services, representatives of local charities, and academics specialising in healthcare.
Many ICBs also invite non-voting ‘regular participants’ and observers to try to get broader contributions, and these include community volunteer organisations, patient advocacy, public health, and CEOs of local trusts.
It goes without saying that the public can only be involved in healthcare planning if they are given access to what the ICB does. Objecting to plans that have already been given the green light is difficult. So, how easy is it for a member of the public to find out about an ICB’s actions and plans?
Public meetings
The vast majority of ICBs hold meetings in public every two months, plus an AGM at some point in the year. However, longer gaps are not uncommon and some ICBs have met in public more frequently. These meetings are the only ones in public. Other committees run by the ICB are not in public, and it is generally unclear how frequent such committee meetings are as they are not advertised on ICB websites.
Agenda and documents
The public meetings are supposed to inform the public what the ICB has done and plans to do. The agenda of the sessions can vary considerably, but the core agenda is a report from the ICB’s CEO, a financial update, a performance and quality report, plus some form of board assurance framework report. The latter report is supposed to be a monitor of how well the ICB is performing against agreed strategic priorities, what is the risk that the priorities won’t be achieved, how the risks can be controlled and what actions are being taken.
Outside of this core, the agenda could include the minutes of other committees, workforce reports, reports on big projects, such as maternity or a new primary care centre, results from consultations, or partner organisations, such as the council or Healthwatch.
For a member of the public, in particular one who does not work in the NHS, the information presented is difficult to interpret and contains few concrete plans. Much of the information is performance data for various partner organisations, including hospital trusts, or reports on past achievements. Outside of the core elements of the ICB agenda, the reports and minutes of other meetings can be many months old.
For organisations that are supposed to be focused on forward planning, there is remarkably little detail of such forward planning. Goals are outlined, but it is difficult to determine just exactly how these goals will be achieved.
Putting Questions
As a member of the public, you can question the ICB and attend the public meetings. However, questions must always be sent in writing days in advance. The question is given at the meeting plus the ICBs’ answer, no follow-up questions are allowed or discussion. Not by any stretch of the imagination is this really being involved with ICB planning.
Joining a forum
Another option could be to join a forum or committee: according to NHS England’s guidance, in addition to opinion and discussion by the board members, the board should be informed through discussion from other forums and organisations, although these have to “have a formal role in the system”, such as public, patient and carer engagement forums (set up by the ICB or Trusts), Healthwatch, and VCSE representative bodies/forums. Groups with no “formal role in the system”, which would include all campaigning organisations, get no automatic access to the ICB discussions.
Responsibilities are unclear
If the lack of access to ICB plans, the opaqueness of its reports, or the complexity of the structure of engagement forums, doesn’t put you off trying to question ICB plans, there is also the issue that the roles and responsibilities of ICBs seem to be more than a little unclear. Lord Darzi wrote in his report on the NHS that more needs to be done to clarify the role and responsibilities of ICBs.
At the end of January, planning guidance for 2025-26 said that a ‘more devolved system’ should be developed. The model will be piloted in some areas where some trusts will take over responsibility for the “planning and transformation” of services from ICBs by March next year. ICBs are no longer going to undertake performance management, but are to focus on “strategic commissioning”.
So just when you’d worked out what the ICB does and how you could possibly influence plans – everything changes.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
Comments are closed.