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How will the latest shake-up in the way the NHS is organised affect learning disability nurses and their ability to do their jobs?
AfC, STPs, SitReps, CHCs… the NHS is notorious for its use of unwieldy acronyms, to the extent the NHS Confederation website has an ‘acronym buster’ with no less than 1,000 commonly used healthcare abbreviations. And here is another acronym to add to that list: ICSs – or integrated care systems.
Learning Disability Practice. 25, 4, 12-13. doi: 10.7748/ldp.25.4.12.s6
Published: 04 August 2022
ICSs are essentially partnerships, bringing together NHS organisations, primary care and local councils in geographic areas. They work closely with voluntary and community groups and their aim is to make health and social care more seamless for patients, promote population health and well-being, and make better use of resources.
The intention is that they will help the NHS eliminate competition between organisations and enable greater collaboration, according to the King’s Fund.
In England, 42 ICSs have been established. The idea was set out in the NHS Long-Term Plan of 2019 and originally due to take place in April 2021, but was delayed. Now, with the passing of the Health and Care Act 2022, they became a legal requirement everywhere in England from July.
ICSs take on strategic planning and make decisions on how NHS money is allocated in their areas. They replace clinical commissioning groups and take on some of the functions of NHS England and NHS Improvement regional teams.
Under the act, two bodies – an integrated care board (ICB) and the integrated care partnership (ICP) – have statutory status and together make up an ICS. The ICB is responsible for NHS services and funding while the ICP covers broader issues, such as public health and social care.
Under this structure, the ICB takes on legal responsibility for NHS resources and commissioning of services in their geographic area.
Each ICS has a non-executive board, including a chair appointed by NHS England and NHS Improvement, a chief executive and other executives. There should be at least three other members drawn from partner organisations, including NHS trusts, primary care and local authorities. The ICP element also has a board.
ICSs encompass place-based partnerships, sometimes called health and care partnerships. These cover smaller areas than ICSs and do not have commissioning powers. However, they have representatives of trusts, local authorities and voluntary and community groups. For example, the Kent and Medway ICS has four of these, each linked with an acute trust. They are likely to be key in designing and delivering local health and care services within an agreed budget.
ICSs also include provider collaboratives, where organisations work together to make collective decisions about health services. They sometimes operate over two ICS areas – for example, a number of mental health trusts working together to ensure that patients needing beds are offered them close to home where possible.
But below all of this, there are ‘neighbourhoods’, NHS England envisages these as covering between 30,000 and 50,000 people – so a town or a region within a city. They are served by a number of GP practices (usually working as one or more primary care networks), and often teams from community services and social care.
There is no legal guarantee of nurse representation on ICB boards, however a number of nurses have already been appointed. But having a nurse at the top of the organisation may not be the only way for the nursing voice to be heard.
‘Let’s hope we don’t just have one nurse on the board, but a team of nurses behind them,’ says Queen’s Nursing Institute chief executive Crystal Oldman.
NHS England and NHS Improvement guidance stresses the importance of clinical and care professional leadership for ICSs at all levels but it is not prescriptive about what form that should take.
‘Most ICSs would want to have some form of professional engagement mechanism. But what that will look like will vary,’ says Chris Naylor, senior fellow at the King’s Fund.
However, nurses are not known for keeping quiet when their interests and those of patients are at stake, says Lancashire and South Cumbria NHS Foundation Trust associate chief nurse Paul Jebb.
‘Nurses go out of their way to make sure their voices are heard. It is vitally important nurse leadership is at an ICS level – to drive patient care, the integration agenda and to bring patient-centred care into system approaches.’
This is an abridged version of an article at rcni.com/ICS-changes
Find out more
CQC (2022) State of care report 2021-21 tinyurl.com/CQC-care-systems
BMA (2022) Integrated care systems tinyurl.com/BMA-systems
King’s Fund (2022) Integrated Care Systems Explained tinyurl.com/Kings-Fund-integrated-care
NHS England (2022) What are integrated care systems? england.nhs.uk/integratedcare/what-is-integrated-care
NHS England and NHS Improvement (2021) Building Strong Integrated Systems Everywhere tinyurl.com/NHS-Integrated-System