Five principles for ICSs on health scrutiny and oversight

Hot on the heels of the updated public involvement participation guidance for NHS organisations planning service changes comes new guidance on health overview and scrutiny committee principles for the new statutory system-level bodies.

The guidance, published on 29 July 2022, foreshadows future statutory guidance on the Secretary of State’s new yet-to-become effective powers to intervene in service reconfigurations introduced by the Health and Care Act 2022. 

It sets out how Integrated Care Boards (ICBs), Integrated Care Partnerships (ICPs) and Local Authority Health Overview and Scrutiny Committee (HOSC) arrangements should work within the new systems-based model of care.

Changes for the Health Overview and Scrutiny Committee

The guidance is clear that, aside from changes to the local authority HOSC power to refer matters to the Secretary of State (SoS), local authority functions will not change. HOSCs will retain their functions of review and scrutiny contained in the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013.

However, the statutory route by which a HOSC may refer a health reconfiguration issue to the SoS under the 2013 Regulations will be amended to reflect the Secretary of State’s new powers of intervention when they come into effect. 

Under this new guidance, the processes governing how HOSCs exercise their powers of scrutiny remain at the discretion of the local authority, though the guidance does recommend that each HOSC develops a "framework to ensure scrutiny work is “effective, focused and adds value”. As a minimum, the framework should enable consideration of:

  • risks, effects and impacts to individual populations
  • risk, effects and impacts to the whole local population
  • support and input from local health colleagues

The guidance highlights that there will be a need for scrutiny at a local place-based level, as well as more strategic scrutiny of health services and system level outcomes.

But what about the wider health and care systems and partners

NHS bodies, Health and Wellbeing Boards and Local Healthwatch will retain their existing functions and obligations in respect of health scrutiny and oversight too. 

Best practice principles for system-level partners

The core of the guidance document is focused on the five new principles for “best practice” working between HOSCs, ICBs, ICPs and other local system partners, which are intended to ensure effective oversight and scrutiny. They are:

Principle 1: outcomes focused

HOSCs are expected to apply scrutiny to key strategies and outcomes of the ICB and ICP, including the integrated care strategy and ICB joint five-year forward plan. They should focus on achieving outcomes for the locality, including:

  • general health improvement
  • wellbeing
  • specific treatment services and care pathways to meet local need
  • patient safety and experience
  • overall value for money

Principle 2: balanced

Scrutiny should be balanced so that it is both “future focused and responsive.” 

Future focused

ICBs and ICPs are expected to agree a set of arrangements so that scrutiny can be built into the whole cycle of planning, commissioning, delivery and evaluation, with leaders operating with “openness and candour”. This should enable system partners to understand how needs are changing and the issues communities face, allowing them to suggest and test solutions, and adding value to integration planning and improvements.


This means responding to issues of concern to local communities, including service performance and reconfigurations.

ICBs should be “working with HOSCs to shape their forward plans” and be proactive in sharing forward plans for reconfiguration and service change. They are to draw a distinction between informal discussions and formal consultations and are to proactively involve relevant bodies on matters expected to be contentious.

Principle 3: inclusive

Local people’s needs and experiences are integral to the commissioning and delivery of health services.  Effective scrutiny should facilitate more inclusive public conversation, including the “right people at the right time”. HOSCs, informed by Local Healthwatch, can do this by enabling democratically elected local councillors to hold systems to account for services and reconfiguration proposals. Systems should consider feedback obtained through the scrutiny processes as a way to incorporate local voices into plans. 

Principle 4: collaborative

Effective oversight and scrutiny require collaborative working. Local authorities and ICBs should work together to this end, in particular where services extend over local authority area borders. Clear local processes and joint protocols for collaborative work should be established so there is no ambiguity as to how they operate. Local authorities are reminded of the requirement to appoint a joint HOSC where a relevant NHS body or health provider consults on service change in multiple local authority areas. 

Principle 5: evidence informed

Scrutiny should be evidenced focused. The guidance says that the type of evidence that aids effective scrutiny include evidence on “quality and safety of services and evidence on population health needs.”  Qualitative evidence of those with lived experience may also be valuable. It notes that in addition to evidence being obtained through systems and NHS bodies, Healthwatch are an important source of evidence for HOSCs, and so they should work closely with Healthwatch to understand the needs of local populations.  

ICBS are expected to have plans in place to share information with HOSCs for purposes of scrutiny to avoid the need for ad-hoc decision-making when information is requested.

Where does this leave us

This new guidance does little to reinvent the wheel and we continue to be left waiting to find out how the SoS’s new powers will unfold.

For now, however, it appears that the existing scrutiny functions remain intact and so will continue to function similarly to before, just with a greater emphasis on collaboration and cooperation befitting of this new era of systems-based working.

You can read our earlier article on the updated public involvement participation guidance here.

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Every piece of content we create is correct on the date it’s published but please don’t rely on it as legal advice. If you’d like to speak to us about your own legal requirements, please contact one of our expert lawyers.

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