What does the Health and Care Bill mean for the establishment and governance of Integrated Care Systems?19/07/21
Those parts of the Bill that transfer commissioning functions from CCGs (and to some extent NHS England) to statutory Integrated Care Boards (ICBs) are some of the most widely-predicted provisions in the Bill. However, the Bill also contains new details of:
- the requirements for ICB constitutions,
- the membership of the ICB and
- the relationship with an Integrated Care Partnership (ICP).
Read more on how the changes will affect you below.
Establishment of ICBs
The Bill imposes a duty on NHS England to establish ICBs that will cover all of England. The geographical footprint of each ICB will be determined by NHS England, and must not overlap with the footprint of any other ICB.
Each ICB will be established through an Establishment Order, in the same way that NHS Trusts were established. The order must either set out the constitution of the ICB (see further below) or refer to a published document where it is set out.
Prior to the establishment of ICBs NHS England will publish details of the geographical footprint for each ICB. It will then be for the CCGs in that footprint to propose the constitution of the first integrated care board to be established for that area. Before making such a proposal, the CCGs must consult anyone they consider it appropriate to consult. This consultation can be carried out before the Bill comes into effect, and given the projected delay in the Bill becoming law, this may well be necessary. NHS England may publish guidance for CCGs about this process, and CCGs must have regard to any such guidance.
Constitution of ICBs
Each ICB must publish its constitution. Schedule 2 of the Bill sets out the following matters that should be contained in the Constitution:
- Name and area covered by the ICB;
- Minimum membership of the ICB to be a Chair; Chief Executive and 3 other members (the “ordinary members”);
- How the ordinary members will be appointed;
- One of the members should be nominated by the local NHS providers;
- Another member should be nominated by local GPs;
- A third member should nominated jointly by the local authorities whose areas coincide with, or include the whole or any part of, the ICB’s area.
- The constitution may also address other membership matters such as qualification and disqualification for membership; the tenure of members and eligibility for re-appointment;
- In common with CCG Constitutions, the ICB constitution will include details of how the ICB will exercise its functions, including its procedures for decision-making and its arrangements for public involvement;
- Also in line with CCGs, the ICB constitution must set out how the ICB will manage potential conflicts of interest.
In preparing the Constitution, an ICB must follow any requirements set out in regulations. It is not yet clear how far the content and format of the ICB constitution will be prescribed either by regulations or NHSE&I guidance and/or model constitutions. However, the learning from CCG constitutions is that a reasonable degree of uniformity would be desirable, and that ICBs should seek to preserve some flexibility so that they are able to make changes to their committee structures or schedules of reservation and delegation without making formal variations to their constitutions.
Integrated Care Partnerships
The Bill amends the Local Government and Public Involvement in Health Act 2007 to provide for the establishment of Integrated Care Partnerships (ICPs). Each ICP will be a joint committee of the relevant ICB and each local authority whose area coincides with or falls wholly or partly within the ICB’s area.
The Bill indicates that the membership of the ICP will consist of:
- one member appointed by the ICB;
- one member appointed by each of the local authorities, and
- any further members as determined by the ICP.
The ICP may determine its own procedures, including quorum.
For more information, please contact Peter Edwards.
Other highlights from the Health and Care Bill
We have prepared a series of “bite sized” updates on those aspects of the Bill that are likely to have most practical impact on your day-to-day work.
What does the Health and Care Bill mean for...