The question many of our ICB clients are now asking as they complete their First 100 Days is “what happens next?” In particular, how do they use the powers set out in the Health and Care Act 2022 to breathe life into their local visions of integration of health and care services at system and place level whilst ensuring that they maintain the necessary standards of good governance, probity and transparency?

In this insight we look at some of the areas where ICB Governance will need to develop further as they progress beyond their First 100 Days.

ICB Governance Stocktake

Understandably, some ICBs developed their initial governance arrangements rapidly in order to meet the statutory timetable for establishment. Now that they have been working to those arrangements for 4 months it is a good time to carry out an initial stocktake to see whether those arrangements are fit for purpose in the challenging environment in which systems are currently working. Some of the things to look out for in a stocktake are:

• Are changes to the SoRD needed to facilitate more efficient use of the time of ICB officers, committees and sub-committees?
• How is the ICB engaging with system partners, and have those arrangements been documented formally?
• Is the ICB managing potential conflicts of interest appropriately?

Delegation of NHSE functions

For those staff who previously worked on the commissioning of primary medical services for CCGs it may seem like there has been little change in the delegation arrangements since 1 July. However, there are some notable changes that ICBs should be aware of. These include:

• The ability to delegate or jointly commission primary care services with NHS Trusts and NHS FTs; other ICBs and local authorities.
• No requirement to maintain a primary care commissioning committee. This is intended to enable ICBs to structure their internal governance in a way that supports their local ambitions.
• The assumption of liability for those functions that are delegated to the ICB.
• Responsibility for handling complaints about primary care functions also transfers to ICBs.

The most significant change to these delegation arrangements will occur next year when the delegation will extend to Pharmacy and Ophthalmic services, and we will share further insights about those changes later in the year.

Delegation to Place and/or Provider Collaboratives

We previously issued an insight in respect of some of the key issues that ICBs should consider when delegating functions to Place or to Providers. Read more here. 

ICBs were advised to delay the formal delegation of functions to Place or to Providers pending the publication of regulations and statutory guidance. These are still awaited. However, we are continuing to work with our client ICBs to develop structures for delegation so that they can “hit the ground running” in 2023/24. It is important to allow sufficient time to build a consensus on how local decision-making in respect of delegated functions will work. We therefore recommend that you continue to discuss these issues with local partners pending the publication of the regulations.

How can Capsticks help?

Since 1 July we have provided a range of support to ICBs across the country including ongoing work to develop their governance and delegation arrangements.
If you’d like to discuss how we can help you with the continuing development of your governance arrangements please contact Peter Edwards.

To access our full ICB; First 100 Days programme, click here.