Are you ready for Integrated Care Systems (ICSs)?

From April 2022, new health and care legislation will come into force, changing the way the NHS and other organisations plan and fund the delivery of care. The development of Integrated Care Systems (ICSs) through the Health and Care Bill will make significant changes, shaking up the system as we know it. 

It's essential that you understand how ICSs will affect the way you work locally, as well as the steps you’ll need to take to be ready for this change. If we aren't prepared as a network, it will be harder for us to get NHS decision-makers to hear people’s views and hold services to account moving forward.

How will the new structure work?

Systems, places and neighbourhoods

As the legislation is debated over the next few months, we will get a clearer view of how the new structure will work. We currently know that NHS England and NHS Improvement have proposed a three-tiered model of systems, places, and neighbourhoods to better integrate care.

At ‘System’ level, the Integrated Care Board (ICB) and Integrated Care Partnership (ICP) will set out the plans and strategy for the area. At ‘Place’ level, local organisations will collaborate on local planning and delivery. ICSs will be based on the principle of ‘subsidiarity’, with planning and delivery being based as close to local communities as possible.

For more information, read the King’s Fund’s explainer guide.

What does ICS guidance say about Healthwatch?

Although the legislation is based on implementation starting from April 2022, guidance has already been published, setting out various aspects of how ICSs will work. Although these may be revised in the light of Parliamentary decisions, they are useful indications of what will be expected of ICSs.

We’ve outlined a quick summary of each guidance document and how they might affect Healthwatch:

1. The Design Framework (June 2021): Sets out the high-level ambitions for ICSs. It also includes the principles that ICSs should use to develop their engagement strategy, building on the existing relationships, good practice and networks across system partners.
2. Thriving Places (September 2021): Looks at what is needed to support work more locally than at System level. It considers how ‘Place’ may be defined, who should be involved and different types of governance. Healthwatch is listed as being expected to be involved at this level. As decision-making will be delegated to the most appropriate level, Healthwatch needs to be clear about when and where decisions will be made. It’s important to note that this is the Place-based partnership which is different from the ICP that works at System level.
3. ICS implementation guidance on working with people and communities (September 2021) Includes System-level guidance setting out how ICSs should work with people and communities. It includes a section on working with Healthwatch, building on current good work, and draws a distinction between Healthwatch and the wider Voluntary, Community and Social Enterprise (VCSE) sector. This guidance can provide a helpful basis for you to discuss engagement plans with ICS engagement leads as well as other Healthwatch in your ICS area.
4. The Integrated Care Partnership (ICP) engagement document (September 2021): Is designed to engage partners in the development of ICPs. It sets out how ICPs should build on existing good practice and structures, such as Health and Wellbeing Boards, and includes "mandatory requirements" and "guiding expectations". It also emphasises the role of Healthwatch “to bring senior-level expertise in how to do engagement and to provide scrutiny”, with the expectation that Healthwatch will be members of the ICP. This guidance has been developed with local government, VCSE organisations and other stakeholders, including Healthwatch England. It will be updated following this piece of engagement.
5. ICS implementation guidance on partnerships with the voluntary community and social enterprise sector (September 2021):  Recognises both the challenges and the benefits of partnership working. It includes different models of engagement, including working at System and Place level, supported by short case studies. Healthwatch across the country have strong relationships with VCSE partners, so it is worth thinking about what you can offer to help build relationships between the VCSE sector and the ICS, particularly to tackle health inequalities.

To support the development of governance arrangements, NHS England has set out the functions of clinical commissioning groups that will be transferred to ICSs and has produced a model constitution. Other guidance covers issues such as the HR Framework, clinical leadership and ICB readiness to operate.

Additional guidance being developed

A working group, which includes Healthwatch England, is currently developing statutory guidance about working with people and communities. This guidance is expected to be completed early in 2022.

What will this mean for you?

Local systems will be working their way through the guidance and deciding what this means, so this is the best time to influence their thinking and remind them of the contribution that Healthwatch can make. When your ICS includes several Healthwatch, you will need to ensure a coordinated and consistent approach so that the ICS has a clear picture. Some of the key questions you might want to consider asking include:

• How will local voices be heard by the ICS?
• What is the ICS strategy for involving local people?
• How will the engagement strategy ensure that marginalised communities are properly represented?
• How can the ICS best use Healthwatch insight?
• How will issues raised at Place level get heard at System level?
• How will the ICS ensure it is transparent and accountable to local people?
• How can Healthwatch best support the development of the ICS?

What is Healthwatch England doing?

We are working at both the national and ICS level to get our message across. Our contribution includes participating in groups that have developed or are currently developing guidance. As the Health and Care Bill works its way through parliament, we are meeting with politicians from all parties to make sure that they understand our case. For example, Sir Robert’s recent appearance at the legislative scrutiny committee was an excellent opportunity to raise the issue of public voice in ICSs, and Healthwatch’s role in supporting that.

Sir Robert has had a programme of meetings with ICS lead and chairs. These help us get a sense of where ICSs are and how they are developing - yet another opportunity for us to talk about what Healthwatch has to offer. Your local insight has been instrumental in the briefings we produce for these meetings.

We are also working with the System Transformation Team at NHS England to identify and promote good practice across the country. The Transformation Team surveyed ICSs and the network to test out relationships. We have also commissioned case studies to show good practice where ICSs and Healthwatch collaborate well, which can also help other areas with ideas to consider and adapt. This work is supported by an ICS Readiness reference group drawn from volunteers across the network.

To help local areas, we are working with Traverse to provide bespoke support for a small number of ICS areas that face particular challenges in developing their partnerships.

As legislation progresses and ICS arrangements become clearer, we will keep you updated on changes that you may need to respond to.