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What now for ICSs?


By Georgina Carr, Chief Executive of The Neurological Alliance

I recently attended the NHS Confederation Expo, during which there was an empassioned plea from NHS England leaders to stick with Integrated Care Systems (ICSs) (including beyond the next General Election, which has to take place before January 2025).

In parallel, the Government also published it’s long-awaited response to both the ‘Hewitt review’ and Health and Social Care Committee inquiry on ‘Integrated Care System autonomy and accountability’. These responses are important, as they set out the direction of travel for how health and care, including for people affected by neurological conditions, will be planned, commissioned and delivered in future.

The Neurological Alliance submitted evidence to both inquiries and responded to their publication back in April, our response is available on our website. A key concern highlighted by the Alliance and others was around the muted initial response from Government to the recommendations made by the Hewitt Review.

What has the Government committed to?

The Committee recommended to Government to review funding arrangements for Healthwatch, as a key driver of patient, public and VCSE involvement. We too called on Government to ensure the right mechanisms were in place for the involvement of people affected by neurological conditions and the voluntary sector.

The Alliance, Hewitt review and Committee all called for clarity on how data (namely on outcomes and experience of care) will be central to ICSs autonomy and accountability. In particular, the Hewitt review notes that “NHS England, the Department of Health and Social Care, ICSs, and Care Quality Commission – and other key stakeholders responsible for the oversight of health and social care – should have equitable access to high-quality information, in its broadest sense, to ensure the accountability of services, and to support their continuous improvement.”

The Government has provided no meaningful response or commitment to give more weight to patient reported experience or outcomes as per Hewitt Review recommendation.  The Government states it “will maintain this focus in the development of a shared outcomes toolkit that will support places to develop their own robust shared outcomes, with priorities and metrics that are directly linked to the needs of their local populations.”

Finally, on specialised commissioning. Specialised services include (adult and paediatric) neurology, neurosurgery, neuropsychiatry, neuropsychology, neurophysiology and complex rehabilitation. Currently, many of these services are jointly commissioned between Integrated Care Boards (ICBs) and NHSE nationally, but are expected to move to ICB responsibility in April 2024. We called on NHSE to ensure clear guidance is in place for the establishment of multi-ICS partnerships, which will be critical to the commissioning of many services for people affected by neurological conditions.

The Government has simply restated their commitment to full delegation of specialised commissioning to ICBs in 2024-25. This has been pushed back with interim joint commissioning arrangements from the initial date of 2023-24 in light of the challenges this presented to newly formalised ICBs. There remain concerns that even with the revised date, systems may not be prepared or equipped to commission these services by 2024-25.

What next?

With a General Election coming in the next 18 months, many working in health and care are calling for stability of health and care structures. Many of our members have told us of their concerns about the establishment of ICS bodies, worried about if and how services for neurological conditions will be considered as part of their planning. But, many are also worried about what further reform (and structural upheaval) would do to productivity.

So, we would join many in the sector in urging caution prior to any further significant reform. The 2022 NHS reforms are not perfect, but do perhaps need the time to breathe and embed if they are to reach their full potential. After all, the ‘integration’ aim of ‘Integrated Care Systems’ is laudable, and could bring many benefits for people affected by neurological conditions if taken forward appropriately.

But, many haven’t moved to integrated ways of working, yet. Most importantly, many have not yet taken the opportunity to consider how they will listen to and meet the needs of the 1 in 6 who live with a neurological condition in their patch.

We urge every ICS to seize this opportunity without delay.