The path towards NHS England’s vision of “integration” of local health care systems is proving a long and rocky one. As we discussed in the previous Lowdown, stubborn Clinical Commissioning Groups in a number of areas are still standing firm against delayed plans to merge them into larger, less local bodies – and now even the delayed North West London merger of 8 CCGs has been obstructed once again.

And despite promises last year to drive forward NHS England’s ambition, set out in last year’s Long Term Plan, of establishing 42 “integrated care systems, to cover England, each spanned by a single CCG, ministers keep postponing their promised new legislation to override sections of the 2012 Health and Social Care Act, and give real powers to the new ICSs.

Despite previous denials that NHS England wanted the ICSs to have statutory powers, NHS England chief Simon Stevens has now told the Health Service Journal that he is expecting the government to push through legislation “in the first half” of next year which will give the new bodies a ‘legal form’.

At present the 18 ICSs that have been established exist largely in name only, standing outside the legal framework of the NHS, meeting and functioning largely behind closed doors, with no formal accountability to the local communities they cover, and dependent on CCGs to enact any decisions.

New laws to change this could sound the death knell for the CCGs, if left as a redundant additional tier of bureaucracy.

Clearly Stevens has now had a change of heart, telling the HSJ: “An integrated care system needs a legal form. That actually is what we proposed in the first place, and as part of drafting proposals it will have to be crystal clear precisely what form that takes.”

So what exactly are the current ICSs doing? Precious little, to judge from their websites, few of which display any signs of life other than a succession of generic press releases about Covid-19 or other general health messages.

It’s not even clear what more they could be doing if they eventually take on a “legal form”. Back in June, The Lowdown trawled through all 18 ICS websites to see if there was evidence of intelligent life, and found little of interest.

Three months later, there is nothing new on the websites for FRIMLEY Health and Care or DORSET, little of significance from Buckinghamshire; Oxford and Berkshire West; North East and North Cumbria; South East London (no meeting since January); South West London (still looking back to its 2016 STP); Suffolk and North East Essex; Sussex, or Surrey Heartlands.

HERTFORDSHIRE and WEST ESSEX’S ‘News Page’ advertises a “next event” as NHS Day, July 5 2019, and while there is a general newsletter for Hertfordshire, the West Essex newsletter has not appeared since May 2019.

SOUTH YORKSHIRE and BASSETLAW has by far the slowest responding website, which eventually confirms that its Collaborative Board still has not met since last October and – as of the last update back in June – there are no meetings or events planned.

HUMBER COAST AND VALE features a 1-page general statement on “Our commitment to engagement”, but this is not linked with any evidence of engagement. “Upcoming events” sum up: “no events.”

GLOUCESTERSHIRE’S ICS website is still locked in a timewarp, featuring its best-forgotten Sustainability and Transformation Plan from 2016.

LANCASHIRE AND SOUTH CUMBRIA, covering five trusts, eight CCGs, four upper tier local authorities and twelve district councils is honest enough to admit that it’s all top secret:

“The ICS Board does not meet in public and the papers are not publically available, at this time. However the ICS Board will review this again in 2020. Key messages from the meetings will going forwards be shared on this page and are available below.”

Needless to say these “key messages” turn out to be vague and evasive descriptions of discussions (in secret) on documents and policies we are not allowed to see:

“The ICS Board noted Finance reports which included the month 4 financial performance for the Lancashire and South Cumbria system in the context of the current finance regime and the response to COVID-19. It covers the revenue and capital positions of all Lancashire and South Cumbria partners and the position on ICS central functions.” No word, then, on whether these positions showed deficits or surpluses.

WEST YORKSHIRE AND HARROGATE’S website appears superficially livelier, and carries video and documents from a Partnership Board meeting in September, but the discussions are at such a level of generality that there is little to indicate any new ground is really being broken by this ICS.

GREATER MANCHESTER has finally added an October meeting to its events page and a few details about its July meeting. It’s a far cry from the ambitious pronouncement that: “We want to keep everyone up to date with Greater Manchester’s devolution plans as they unfold. Here on our public meetings and events page, you can quickly find information on upcoming board meetings (which anyone can attend), as well as download papers from previous sessions. So you can see what’s going on, where and when…”

NOTTINGHAM AND NOTTINGHAMSHIRE ICS, however gives a clue as to what some of these ICSs are doing behind the scenes: its most recent papers include aData, Analytics, Information and Technology (DAIT) Strategy 2020-2024’.

It is notable for ignoring any issues of digital exclusion for a significant section of the population including some of the most deprived and vulnerable, and for its misleading use of statistics – such as citing a “178% increase in NHS App login from February 2020 to May 2020” without pointing out that the increase is from a very small base (14,200) compared with the catchment population of 1 million-plus.

It throws in claims from “Connected Nottinghamshire public engagement and research” – in 2018 – that “73% of people in Nottingham or Nottinghamshire would like access to digital service to manage their health,” and “59% … would like to access health and care appointments via video consultation” – but makes no attempt to explore why the other 27% and 41% have decided the other way, or how they might be reached.

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