In this article, our dedicated ICS team consider the Thriving places guidance on the development of place-based partnerships as part of statutory ICSs and the implications for organisations arranging and delivering health and care services in a locality or community.
Broadly, the guidance aims to support all partners working in ICSs to define and develop their place-based working arrangements, activities and governance. It says that the intention is to support existing arrangements – and not to disregard partnership approaches that are already working well.
ICSs will need to confirm their initial proposed place based partnership arrangements for 2022/23, including:
- their configuration and size as well as the boundaries of the ICS’s places
- the system responsibilities and functions to be carried out at place level
- the planned governance model, including membership, decision-making arrangements, leadership roles as well as agreed representation on, and reporting relationship with, the Integrated Care Partnership (ICP) and Integrated Care Board (ICB)
The guidance confirms that these arrangements should be mutually agreed between the NHS, local government and other system partners.
So, what is said about defining the geography of place?
There is a palpable steer in favour of places within ICSs reflecting local authority boundaries as these LA areas are “well understood” by local communities. But there is also a need to consider local NHS services and their geographical catchment area, such as how primary care networks (PCNs) and other community-based health services at neighbourhood level are organised, for example.
A number of “contextual” factors are also identified as important issues for partners to consider when defining their place, such as Health and Wellbeing Boards (HWBs) footprints, existing partnerships and geographical features or infrastructure that influence the way people use services.
There would appear to be sufficient flexibility in the guidance for system partners to build on existing arrangements and agree boundaries while recognising that in some smaller ICS footprints, system and place will be coterminous.
Governance models, decision making and accountability
The NHS, local government and other local partners will need to agree the planned governance model for place, including:
- membership (the guidance advises considering representation from mental health, the VSCE sector, community, social care providers, the ICB, primary care and providers of acute care, for example)
- place level decision making arrangement, including any joint arrangements for statutory decision making functions between the NHS and local government
- leadership roles, for convening the place-based partnership, as well as any individuals responsible for delegated functions
- representation on, and reporting relationships with, the ICP and ICB
A number of governance models are proposed that can be established at place, subject to the passage of the Health and Care Bill, such as a consultative forum, a joint committee, individual staff exercising delegated functions and lead provider models.
The guidance acknowledges that in some places, the HWB has provided a forum to align decision-making between local government and NHS partners. Section 75 partnership agreements are used to enable joint decision-making between local authorities, NHS commissioners or providers for the commissioning of health or social care services. Looking ahead, local areas will need to consider how to balance and build on existing relationships and governance arrangements – and explains that HWBs will have specific requirements set out in legislation in relation to fulfilling duties of the ICB.
One aspect of the guidance that we would like to see clarity around is the issue of accountability – and what the place based partnership is accountable for and to whom. The guidance provides that partnerships will need to agree reporting relationships with the ICB and ICP. NHS providers’ view is that it is “essential to avoid duplication between trusts’ and place-based partnerships’ accountabilities, especially if ICBs delegate decision-making and budgets to places.”
Another area we see as key to providers operating successfully at system, place and neighbourhood level, is having good governance arrangements in place. So whilst the guidance recognises that some providers will be members of an at-scale provider collaborative and one or more place-based partnerships, it will be essential for providers to work with place-based partnerships to ensure that their role at both place and system level is clearly defined to avoid duplication and conflicts between the collaborative arrangements. It will require organisations to work together and agree the governance structures to ensure that each organisation understands their roles and responsibilities, whether they are operating at system level, place or neighbourhood.
How we can help
Our team have worked with place based partnerships, provider collaboratives and systems helping them establish their contractual models to implementing them successfully.
We know that creating and planning effective provider collaboratives and place-based partnerships is challenging so we have created our Integrated Care Systems hub page to support you. You can view the ICS Hub here.