The government’s Health and Care Bill has run in to more stormy waters as it continues its committee stage in the House of Lords. Critical voices have been raised about the way so-called ‘integrated care systems” (ICSs) are being established on the ground, and the extent to which these are pre-empting the parliamentary debate. 

One main focus of criticism of the way the machinery of local integrated care boards is already being put in place, five months ahead of the postponed implementation date, has been the guidelines issued by NHS England that have been used in some areas to exclude elected councillors from representing local government on Integrated Care Boards (ICBs). 

The insistence that only unelected council officials should be the voice of their authorities has been forcibly challenged from various benches, not least Lord Scriven from the Liberal Democrats, who complained: 

“We are living in a parallel universe. We are discussing the legislative framework for this new system while, out in the real world, the foundations and the bricks are being built.  

“People are in place. Dates are being set. People are being told that they cannot be on boards. This Parliament has not decided. Under what legislative framework are these organisations working?   

“They have no legitimate powers or approval from Parliament, yet they are being set up. People are being put in place. Chairs are being appointed. Councillors are being told that they cannot sit on ICBs.” 

The strong protest at the way this was being done forced Lord Kamall from the government to promise to “go back and have a stronger conversation with, in effect, my boss” as well as NHS England, whose guidance on the constitution and composition of ICBs, he insisted, was not statutory. 

However some of the amendments proposed could have the effect of forcing NHS England and local ICSs to reopen the appointments process which they began prior to any parliamentary approval of the legislation. 

Meanwhile the hugely uneven way in which ICSs have been constituted and begun to function in advance of statutory powers, which we have highlighted in The Lowdown, is underlined again by an HSJ analysis that shows just half of the 42 ICSs published board papers in 2021, and 16 ICSs have never published any papers to indicate what they have been planning or discussing. 

And in Norfolk and Waveney ICS, the chair of one of the acute trusts has broken the usual polite silence by declaring that the proposed structure of the ICS, involving no less than twelve separate bodies, is “absolutely daft,” and she was “struggling to navigate what each group does”. 

A look at the document from the “interim partnership board” confirms her view, explaining the complex network of bodies beneath the ICB: 

“We are creating five local health and care alliances (‘Alliances’) based on our current health localities. … They will be accountable to our Integrated Care Board (‘ICB’).  

“We are also creating 7 local health and wellbeing partnerships (‘Partnerships’) alongside our Integrated Care Partnership (‘ICP’) to progress our work on addressing the wider determinants of health, improving upstream prevention of avoidable crises, reducing health inequalities, and aligning NHS and local government services and commissioning. These partnerships will be based on district footprints.” 

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