Our response to the Health and Social Care Committee Inquiry on ICS accountability and autonomy


The Health and Social Care Committee launched an inquiry into how Integrated Care Systems (ICSs) will deliver joined up health and care services to meet the needs of their local populations. The inquiry also considered how ICSs could and should balance increased flexibility over budgets and commissioning with the need for clear accountability. We responded to the inquiry’s call for evidence and would like to thank all those who contributed.

ICSs on a statutory footing

From 1 July 2022, 42 Integrated Care Systems (ICSs) in England have been put onto a statutory footing. This means they have a basis in legislation under the Health and Care Act 2022 and have formal powers and accountabilities.

While some ICSs have been in place well before July, these were previously voluntary partnerships. Now ICSs have statutory responsibility for allocating NHS budgets and commissioning services, including services for people with neurological conditions.

This King’s Fund explainer sets out what these changes mean in more detail.

Addressing unwarranted variation

In our response we have highlighted the fact that this increased delegation of powers and responsibilities to ICSs must not exacerbate unwarranted variation in access to or quality of services for people with neurological conditions. Unwarranted regional variation was a key feature of the recent Getting it Right First Time (GIRFT) in Neurology report. The report found key differences between local services including in relation to access to specialist nursing, some treatments and specialist neurology input.

Responses from our UK wide patient experience survey, My Neuro Survey, showed that those living in areas of higher deprivation were more likely to report delays in access to treatment and care. In our response we highlighted a series of recommendations informed by experiences shared through My Neuro Survey and set out in our Together for the 1 in 6 England Policy report which would provide a framework to help ICSs address inequalities in care.

People affected by neurological conditions must be heard and have influence

Supporting people affected by neurological conditions and patient organisations to be meaningfully involved at all levels of Integrated Care Systems is key to delivering effective and efficient services. In particular, underrepresented groups must be supported to engage in relevant ICS structures.

While the Health and Care Act presented a missed opportunity to increase patient voice and public involvement, there remains an opportunity at to increase and improve meaningful patient and public voice (PPV) engagement at System, Place and Neighbourhood level.

Clarifying Multi-Integrated Care Board (ICB) working arrangements

Services for low prevalence or rare neurological conditions, and/or where services are scarce are unlikely to be a priority for Integrated Care Boards (ICBs).

For these services, how systems work together to provide services and specialist input will be vital.

Our response calls for urgent clarity and greater detail around the expectations of multi-ICB working arrangements, including in neurosciences. This is particularly important for specialised services for which commissioning responsibilities are set to be delegated to ICSs from April 2023.

Improving data and evidence

Good quality data is a key element of the population health approach adopted by many ICSs and  plays a vital role in making sure services can be planned and commissioned appropriately.

A key challenge is the absence of good quality NHS data for many neurological conditions, particularly rarer conditions.

Agreed outcome measures, implemented and used consistently across the system, are critical in addressing health inequalities, unwarranted variation and improvement of services for people with neurological conditions. In our response we urge the Committee to support our calls for NHS England and NHS Improvement to adopt and mandate these measures as a matter of urgency.

Role of service specifications, optimum pathways, clinical policies and Clinical Reference Groups (CRGs) 

While significant commissioning and budgetary responsibilities are being delegated to ICSs, clinical standards will still be set centrally and administered by NHS England and NHS Improvement. Service specifications are a key element of ensuring consistency in the quality of services. Several key service specifications for people affected by neurological have been in development for years, including the neuropsychiatry service specification and neuroscience service specification.

Our response calls for these to be finalised and published before commissioning responsibilities are delegated. Our response also makes the case for the neuroscience transformation programme to continue at pace and recommends that National Clinical Directors in neurology and neuroscience be swiftly appointed to support its progress. We have also recommended that available optimum pathways and guidance be used to support ICBs and Integrated Care Partnerships (ICPs) to improve local care and population health.

Neurology and neuroscience must be prioritised

There remains a crucial role for national political leadership around services and support for people with neurological conditions. That’s why together with Neurological Alliances across the UK, over 100 member organisations and over 12,000 people, we’re calling for all UK Governments to work together establish a Neuro Taskforce. You can read more about our Taskforce proposals here.

Giving people affected by neurological conditions the prioritisation they need would help to ensure that all ICSs deliver the right care and support at the right time for the 1 in 6 of us with a neurological condition.

In our response we urge the Committee to support our calls for a Neuro Taskforce and the much-needed improvements in access to and quality of services it would help deliver for people affected by neurological conditions. Read our full response to the inquiry here.