Integrated Care Boards to get the commissioning function

Rob Day discusses the successors of Clinical Commissioning Groups and the CCG’s role in forming the new Integrated Care Boards in the second of a series of articles on the new Health and Care Bill.

Under the new Health and Care Bill, the spiritual and functional successors of Clinical Commissioning Groups (CCG) are the Integrated Care Boards (ICB), which will be bodies corporate. It appears that the vehicle for collaboration on commissioning is the ICB. 

The model for the ICB is like the CCG but with less emphasis on GPs. It is like a CCG without the membership and with wider representation on its governing body – in effect, the governing body is the ICB. The minimum requirements for an ICB are a chair (appointed by NHS England with Secretary of State approval), a chief executive (appointed by the chair with NHSE approval), a representative of the local NHS Trusts and Foundation Trusts (that’s one for all of them), a representative of local primary care providers (ditto) and a local authority representative (one appointed by the local authorities in the ICB’s area).  ICBs will commission services for their areas.  As with CCGs, NHS England has draconian powers if they are failing.  Further evidence of the succession theme is provided by what happens on dissolution of the CCGs.  The transfer schemes to be made on abolition of CCGs will transfer the property, rights and liabilities of CCGs to either NHS England or an ICB.  The Bill also says transfer schemes may “make provision which is the same as or similar to the TUPE regulations”, which is the trendy new equivalent of a staff transfer order.

Although the phrase “integrated care system” is used in clause and schedule headings, it does not appear anywhere in the text of the Bill; “integrated care systems” (plural) is not used at all.  Most of the changes in the schedule headed “integrated care system: minor and consequential amendments” are to replace “clinical commissioning group” with “integrated care board”.  However the explanatory note does use “integrated care systems” five times: three times in describing the landscape the Bill replaces, once in referring to the schedule we mentioned above and once in a paragraph about the financial consequences of the Bill, where is says this:

“As such, it is difficult to monetise any costs at this stage. The measures in the Bill that may result in cost include, but are not limited to:

• The establishment and running of Integrated Care Systems (comprising of the Integrated Care Board and the Integrated Care Partnership)”.

So, at last! An ICS is an Integrated Care Board plus an Integrated Care Partnership. 

Under the Bill, an Integrated Care Partnership (ICP) is a joint committee for the ICB’s area with one member from the ICB, one member from each responsible local authority and other members appointed by the Integrated Care Partnership (the joint committee) itself. The ICP must devise a strategy setting out how the local population’s “assessed needs” under section 116 of the Local Government and Public Involvement in Health Act 2007 are to be met by the exercise of ICB, NHSE and local authority functions, which is described as the “integrated care strategy” (another ICS).

So in that sense, at commissioner level, we have the integration (or at least hope of alignment) of an NHS commissioning body which includes a local authority person and a joint committee which may be local authority dominated depending on the number of responsible local authorities in the ICB’s area.

CCG clients will be familiar with the process for establishing the initial Integrated Care Boards, which the Bill sets out in a new section 14Z26 for the NHS Act.  The section requires NHS England to publish a list of the areas for which ICBs are to be established, following which the CCGs for those areas must make an application for the creation of their local ICB by submitting their proposed constitution.  As the Bill is currently written, who they consult is up to them.

In short, the Bill suggests that CCGs will have a big role to play in forming the ICBs.

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