John Lister comments –

Thirteen areas have been given just over three months (to next April) to rebrand themselves as “Integrated Care Systems” (ICSs), regardless of local views and aspirations, with the threat that any laggards will be pressed into line by an “intensive recovery support programme” driven by regional level NHS England bureaucrats.

All 13 are still at the stage of “Sustainability and Transformation Partnerships,” after new raft of eleven ICSs rubber-stamped by NHS England early in December brought the total of ICSs so far authorised to 29 out of a target of 42 to cover the whole of England. 35 million people, 60% of England’s population, are now covered by an ICS.

The process, ludicrously described by NHS England bureaucrats as a “bottom-up” reorganisation of the NHS, is now being driven relentlessly and quickly – from the top.

But exactly what is meant by an ‘Integrated Care System’ remains hazy, not least because there is as yet still no date for new government legislation that is necessary for ICSs to have any legal status or powers. Indeed despite the rush to put them in place the new ICSs are not expected to be fully functioning until April 2022.

NHSE claims the new ICSs have shown “robust operational and financial plans and proposals for collective leadership and accountability” – but two of them (Cornwall & Isles of Scilly and Norfolk & Waveney) are languishing among the worst ten performances on A&E, with trusts admitting fewer than 70% of the most serious ‘Type 1’ A&E patients within 4 hours, against a national target of 92%.

There are also stubborn performance and capacity issues in five of the remaining 13 STPs that are required to step up to ICS status by April, but are currently England’s five worst performing areas on A&E. Lincolnshire is the worst in the country admitting just 54% of Type 1 patients within 4 hours, followed by Staffordshire & Stoke on Trent (56%), Northamptonshire (65%), Leicester, Leicestershire & Rutland(66%) and Shropshire & Telford (67%).

In some of these remaining areas the merger of Clinical Commissioning Groups as a basic starting point for an ICS has been resisted by GPs, by local government and campaigners. They have highlighted the loss of any local accountability to communities, and fears that establishing an ICS with a “single pot” of funding would result in further cutbacks and erosion of services. Local health chiefs have just weeks to find ways of sidelining this opposition.

Meanwhile NHS England is still going through the motions of a “consultation” on which of two unacceptable proposals for giving ICSs legal status and powers should be adopted. This concludes on January 8, but until the consultation process is complete and firm proposals put forward – which could run into the following month – it’s unlikely any legislation will be tabled.

This will also be a period of continued crisis in the NHS with winter pressures and a likely third wave of infections following Christmas – and of course all of the economic uncertainties and disruption of what seems likely to be a no-deal Brexit on January 1.

* The newly authorised ICSs are Bath & NE Somerset, Swindon and Wiltshire; Birmingham and Solihull; Bristol, North Somerset and South Gloucestershire; Cornwall and Isles of Scilly; Derbyshire; Hampshire and Isle of Wight; Norfolk and Waveney; North Central London; North East London; North West London and Somerset.

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