As mentioned in the last edition of Health News, NHS England and NHS Improvement have just released the ICS Design Framework, a new document to support the development of integrated care systems in England.
Ahead of the imminent publication of the Health and Care Bill – which will give effect to the recent Integration and Innovation white paper – this latest document sets out some of the main ways NHS leaders and organisations will operate with partners in ICSs from April 2022, when the reforms are scheduled to come into force. The document includes more information on how the two parts of the proposed ICS structure – the ICS Partnership and the ICS NHS Body – will be formed and how they will operate. Most significantly for UNISON members, it also includes further detail on how the transition to the new system will be managed from a staffing point of view.
This short briefing covers the main headlines on the new structures and ways of working, followed by a dedicated note on the proposed transitional arrangements for staff.
New structures and ways of working
The ICS Partnership (referred to in previous publications as the ICS Health and Care Partnership) is confirmed as a forum rather than a corporate body that will bring the NHS together with local government and others to integrate care and improve health and wellbeing outcomes. It will be responsible for drawing up an “integrated care strategy” for the local population. The government does not intend to bring forward prescriptive legislation about how Partnerships should operate, but formal guidance will be produced for consultation, and the Design Framework gives a flavour of what is likely to be included.
Of particular note, the document states that Partnerships “will need to be transparent with formal sessions held in public”. The potential membership of Partnerships is likely to be the cause of controversy with fears (shared by UNISON) that private healthcare providers could have a role – the white paper expressly included “independent sector partners” in the list of those who could be members. The Design Framework is less explicit, but still leaves scope for such organisations to be involved; it refers to the “voluntary, community and social enterprise” sector, social care providers, and “organisations with a relevant wider interest”.
Meanwhile, the ICS NHS Body is confirmed as the real powerhouse of the new system, with this expected to take on all functions and duties of clinical commissioning groups, including their commissioning responsibilities and contracts. They are charged with leading integration within the NHS, “bringing together all those involved in planning and providing NHS services to take a collaborative approach to agreeing and delivering ambitions for the health of their population.” The NHS Body will also be responsible for leading system implementation of the People Plan, including closer collaboration across health and social care on workforce matters.
Each NHS Body will have a board of at least 10 mandatory members. These include: four executives (a chief executive, and finance, nursing and medical directors); three independent non-executives (a chair and two others); and three “partner members” (one from a local trust or foundation trust, one from general practice, one from a local authority). All board members will be expected to comply with the Nolan Principles of Public Life and must meet the Fit and Proper Persons test. Further detailed guidance will be published in due course.
Elsewhere, the Design Framework includes a wider reference to the need for ICSs to have public meetings and to publish minutes. In terms of the private sector, there is also a short section which states that “all providers, including independent providers to the NHS and local authorities, will need to be engaged with other relevant partners in the ICS, through existing or newly formed arrangements, to ensure care meets the needs of the population and is well co-ordinated.”
Managing the transition and staffing
The Design Framework includes a section on managing the transition to statutory ICSs, which confirms that NHS England / Improvement will work with trade unions and others to ensure the easiest transition to the new system. As referred to in previous UNISON briefings, the document confirms that there will be an aim “to create an environment that enables this change to take place with minimum uncertainty and employment stability for all colleagues who are involved.”
A crucial part of this will be the “Employment Commitment”, which is worded as follows:
“NHS people within the wider health and care system (below board level) affected directly by these legislative changes, including CCGs, NHS England and NHS Improvement and NHS providers, will receive an employment commitment to continuity of terms and conditions (even if not required by law) to enable all affected colleagues to be treated in a similar way despite a variety of contractual relationships. This commitment is designed to provide stability and remove uncertainty during this transition.”
This commitment is an improvement on previous NHS overhauls where no such undertaking has been given, and it is significant that it covers those working for providers (rather than just those more obviously affected by the latest reforms), which should provide protection for those staff moving to work in other parts of the health and care system.
The Design Framework has an indicative timetable (on pages 51-52) giving more detail on when elements of the overall transition are expected to have taken place, and the document refers to the newly formed ICS Transition Partnership Group, which UNISON is a part of.
UNISON Policy Unit, June 2021