The Government published a White Paper in February 2021 which they say gives the blueprint for future NHS and Social Care reforms. It is hoped that the new proposals, which build on the NHS’ Long Term Plan, will join up health and care services and embed lessons learned from the pandemic. In Derbyshire, these proposals are welcomed and in line with the direction of travel being planned by the Joined Up Care Derbyshire Integrated Care System. 

The White Paper details plans to support recovery by stripping away unnecessary legislative bureaucracy, empowering local leaders and services and tackling health inequalities. The government is proposing a Bill will be laid in Parliament, when parliamentary time allows, to carry the proposals into law. The Government intends to bring forward separate proposals on social care reform later in 2021.

In particular, the Government’s announcement - following recommendations made by NHS England - includes proposed legislation to set out the future of Integrated Care Systems (ICS). Joined Up Care Derbyshire was announced as the ICS for Derby and Derbyshire following its prior status as an STP, with effect from 1st January 2021, and this new announcement sets out the next stage in development, including the legal powers for ICSs across the country.

What has happened so far? 

NHS England asked local health and care systems for their views on giving ICSs increased statutory powers in November 2020. Overall, the proposals met with the direction of travel and aspirations for Derbyshire, outlining four main aims:

  • Improving population health and healthcare.Margaret Beaudioun - Derby.jpg
  • Tackling unequal outcomes and access.
  • Enhancing productivity and Value for Money.
  • Helping the NHS to support broader social and economic development.

The proposals talked about existing CCG commissioning responsibilities becoming part of the ICS, and set out a new landscape for collaboration among service providers working both at scale and in our neighbourhoods. NHS England has reviewed this feedback and has made five specific recommendations to Government, which the Government has now agreed to legislate.  The Government published it's draft legislation on 6th July which will follow the usual passage of bills through Parliament.  The important second reading of the bill is likely to take place before the parliamentary summer recess in 2021.   You can read NHS Provider's summary of the draft legislation here.

What Does This Mean for Derbyshire?

In real terms, for Derbyshire, this will mean:

  1. A statutory NHS Integrated Care System (ICS) which builds on the significant progress already made by Joined Up Care Derbyshire, likely to take effect from April 2022 subject to parliamentary process and legislation. NHS and local authority partners will continue to work together to implement these reforms.
     
  2. The establishment of statutory ICSs would see the creation of an ICS NHS Board and an ICS Health and Care Partnership (together referred to as the ICS), to strengthen the decision-making authority of the system leadership and to embed accountability for system performance into the NHS accountability structure.
     
  3. The ICS Health and Care Partnership, will bring together health, social care, public health (and potentially representatives from the wider public space where appropriate, such as social care providers or housing providers). This body will be responsible for developing a plan that addresses the wider health, public health, and social care needs of the system – the NHS ICS board and Local Authorities will have to have regard to that plan when making decisions.
     
  4. A process where the commissioning functions currently delivered through the CCG - as well as a number of commissioning functions currently undertaken by NHS England - transition into the new ICS NHS Board, with a guarantee on employment for everyone below Board level.
     
  5. A key responsibility for our system will be to support place-based joint working between the NHS, Local Government and other partners such as the voluntary and community sector. The White Paper proposes that frequently, place level commissioning within an integrated care system will align geographically to a local authority boundary, and the Better Care Fund (BCF) plan will provide a tool for agreeing priorities.

    This will see ongoing work on how NHS providers collaborate both at scale across some service lines, and at neighbourhood or place level to ensure services are tailored to local citizens. The Government has explicitly noted that the creation of new NHS Trusts remains an option, with the removal of many of the traditional commissioner/provider boundaries.

ICS Design Framework

In June 2022, NHS England published the ICS Design Framework, which provides more information on how ICSs will be established, including the proposed membership of the ICS NHS Board and the way in which funding may flow into Derbyshire.  You can read the NHS Confederation's briefing on the Design Framework here.

More information

Please visit our pages to find out more information: 

Design Framework
Collaboration at Place and at Scale