Submission to the Health and Social Care Committee inquiry into integrated care systems: autonomy and accountability
This submission responds to several of the questions set out in the inquiry terms of reference, including questions on balancing autonomy and accountability, developing a permissive approach in practice, the role of central targets, local variation and maintaining a focus on prevention alongside wider system pressures.
Summary
Many of the answers to the challenges currently facing the NHS lie in closer collaboration with local government and voluntary sector organisations, and it is vital that national NHS bodies hold ICSs to account in ways that encourage rather than deter the involvement of these partners.
Although ICSs are intended to be a fundamental towards leadership based on partnership, there is a significant risk of recreating established ways of working within the new structures. This could be exacerbated by forms of accountability and oversight that encourage local leaders to focus on organisational performance at the expense of broader system change.
National accountability must be complemented by strengthening arrangements for local accountability within systems, with the partner organisations involved in an ICS holding each other to account for the commitments they have collectively agreed to.
The historic approach of NHS top-down performance management can be useful under specific circumstances, but it is not the approach that will allow ICSs to flourish. To make a success of the local partnerships that underpin the current reforms, national and regional teams must develop a more enabling, collaborative form of leadership, working alongside systems to support improvements in care.
National targets have an important role to play but to avoid creating significant unintended consequences it is important that these are realistic and achievable.
National targets should be kept within a manageable number to avoid crowding out local priorities that respond to local needs.
NHS England will need to work with other national bodies to develop targets and oversight frameworks that balance prevention, treatment and care.
ICSs are intended to be whole-system bodies, but they are held accountable nationally through NHS England whose primary responsibility is for NHS services. To correct this mismatch in scope, the integration taking place within local systems needs to be mirrored at the national level.
One of the strengths of ICSs to date is that they have developed in response to local needs and circumstances, and it is vital that this continues to be the case. This means that a degree of variation in structures and arrangements is both inevitable and necessary. National bodies need to strike the right balance and tone in their interactions with ICSs to avoid undermining local ownership.
‘No man’s land’: the experience of patients at the interface between health and social care
Patients can fall into a ‘no man’s land’ between health and social care, where poor coordination, fragmented services and unclear responsibility lead to gaps, delays and poorer experienc...
What we learned as an ICS – and why we need to ‘softwire’ our future local health and care systems
As the NHS and local government embark on yet more structural reform, Susannah Howard shares the learning from ten years of system working in Suffolk and North East Essex.
What is neighbourhood health?
The government has put a 'neighbourhood health service' at the heart of its vision for the NHS – but what does that actually mean for staff and patients? And how might it be implemented ...
)
Neighbourhood and integrated care summit: putting people at the heart of health and care
There is growing momentum behind neighbourhood health, but translating vision into practice is complex. We hear consistently from professionals and communities that what is needed most i...