Action Needed to Ensure Opportunities of New Health Care Restructure are Realised, Warn MPs

The Committee’s report into new partnerships aimed at delivering joined-up health and care services is calling for the Government and NHS England to address key concerns if an opportunity to deliver real change is to be realised.

The inquiry, with a focus on autonomy and accountability, found genuine enthusiasm for the potential of ICSs to deliver on challenges facing the health and care sectors. However, MPs warn of a serious lack of clarity in some areas with risks that acute short-term pressures could be given priority over longer term ambitions such as preventing ill-health.

MPs also express concern that the success of the restructuring programme could be jeopardised if NHS England continued to take a “command and control” approach. The Report says it is vital that the Government and NHS England should not dictate how ICSs deliver local outcomes.

The restructuring programme established 42 Integrated Care Systems in England that came into force in July 2022.

Chair of the Health and Social Care Committee Steve Brine MP said:
“This is a key moment for Ministers and for NHS England. We have found genuine enthusiasm for the potential of Integrated Care Systems to make a real change, not only in how health and social care is delivered but in prioritising the needs of local populations and preventing ill-health.
“It would be an opportunity lost if that success was undermined by the need to prioritise central government targets or a focus on meeting short-term demands. We urge Ministers not to lose sight of the crucially important prevention agenda and we call for them to adopt a light-touch outcome driven approach to this new way of working.

“We were pleased that the Government commissioned the Hewitt Review, considering similar themes to our own inquiry, and welcome the spotlight that is being shone on ICSs at this early stage in their development. We hope to see this focus maintained and look forward to considering the Review’s findings.”

Key recommendations to Government/NHS England:
• Targets for ICSs set by DHSC and NHS England should be based on outcomes, greater prescription around how targets are achieved should be done sparingly.
• Any update to NHS England’s Long-Term Plan must put prevention and long-term transformation at its heart.
• Integrated Care Boards should ensure they include a public health representative, such as a public health director or public health lead.
• DHSC should gather information relating to the membership of ICBs and then review to understand whether further mandating is required.
• DHSC, working with ICSs, should set out action that could be taken to resolve issues of poor partnership working, especially with social care.
• DHSC should urgently provide the CQC with its decision on ratings and any priorities it would like the CQC to focus on.

Please see attached Report for a full list of conclusions and recommendations.

Improved outcomes in population health and healthcare are a core purpose of ICSs, however the Report notes that public health professionals are not mandated to sit on Integrated Care Boards, one element of the partnership. MPs voice concern that without this expertise, longer-term priorities will not be addressed, fearing that the changes instead will continue ‘a sickness service’ rather than produce a health service fit for the future.

The Report concludes there is a clear risk that short-term, acute pressures will dominate ICS capacity, with evidence that has highlighted the scale of the challenge if they are to balance immediate pressures with longer-term work.

MPs express concern that though the CQC will assume legal powers to assess ICSs from April, the Government has failed to clarify key aspects such as whether ratings are required and the priorities that an assessment would be based on.

Evidence given to the Committee also raised concern about the exclusion of adult social care in new systems and the risk of ICSs becoming ‘NHS-centric’.