Councilors have expressed fears that the NHS is using the structure of the new Integrated Care Systems (ICS) to seize power from councils and sideline the voices of local communities.
Forty-two ICS are due to come into effect in 2022, replacing the powers of clinical commissioning groups – although in December the target transition date was moved from April 1 to July 1.
At a meeting of the Local Government Association’s Urban Regions Board of Directors this week, councilors predicted “rough waters” as the new system takes shape.
ICS will include Integrated Care Boards (ICBs), intended to bring the NHS together locally, and Integrated Care Partnerships (ICPs), a wider alliance of local representatives convened by boards and the NHS.
NHS moves to exclude advisers from ICBs have sparked suspicion in local government, with advisers fearing the health service is seeking to claw back public health powers and seize more funds for acute services.
A report to the LGA meeting says NHS England’s model constitution for ICBs ‘explicitly excludes councilors and MPs’ and although this model is not stipulated by the Health and Care Bill which will establish the ICS, many ICBs fear adopting the exclusion clause.
“The LGA has made strong representations for [NHS England] for this to be removed from the model constitution, but it was not successful,” the report said.
Although this is ‘concerning’, it says advisers are ‘more likely to be able to play a leading role in PICs’.
The report also notes that in November the board discussed “concerns that the NHS will use ICS to reclaim the power of advice on public health matters”.
Danny Thorpe (Lab), leader of Greenwich LBC and executive member of the London Councils for Health and Care, said at the meeting: ‘Our main issue with the two councils setup is that you can’t have a bunch of medical professionals sitting in a room. with all the money, and local government people sat around talking about how wonderful it is to work together.
He said London is “really trying to make sure that ‘ICP in one area’ gets the resources, the strategy, and then kicks off this trip for the year. Unless we do it alongside our partners from health, we don’t think the whole thing is working”.
He added that “there is still work to be done, so that the system is clear on the role that elected officials can play”.
Sunderland City Council leader Graeme Miller (Lab) has slammed the NHS for an ‘attempt at political castration’ to exclude politicians from ICBs which would mean ‘the review is effectively being ignored at the level local”.
He said it was “a terrible decision, because I’ve always found the NHS, when it talks about itself, to say nothing but rubbish”.
“You need adults in the room who understand local service delivery and what residents really want. By the way… they see the boards progressing, the highs will absolutely gain in power and money. That’s the whole story.”
Cllr Miller also expressed concern that health and wellness advice is being ‘diminished’, saying that ‘when you look at the future path… they are effectively isolated from key decision-making’.
He added he was “very nervous” about the size of the North East and North Cumbria ICS.
“Exactly how having an ICS that stretches from the Scottish border to South Yorkshire is going to provide place-based service delivery to residents of the Castle district in Sunderland…Christ knows that. “
“It’s a car crash happening, but the NHS will force it through. What we need to try and do is make them listen to reason and hopefully listen to us and understand that the structure of the local authority is a very good partner for them. But then they have to treat us like adults. We are not here as a tick box exercise.
John Merry (Lab), deputy mayor of the City of Salford, said the new structure felt like a “step backwards” for his council because Greater Manchester “already [has] a fully integrated budget with the NHS and joint decision-making”.
He said there was a “very real concern” that the structure of the ICS “doesn’t necessarily reflect that”.
He added that with two big NHS acute trusts in the area, ‘we’re going to have some pretty big behemoths battling it out…and I’m afraid the integrated budget we’ve carefully developed in places like Salford will have us been removed”.
The postponement of the transition to ICS indicated that “it’s not as smooth as people thought,” said Cllr Merry, who predicted “pretty choppy waters as we try to work out the precise relationship between the NHS and local government”.
David Fothergill (Con), the chairman of the LGA’s Community Welfare Council, said that “as local authorities we think we bring a lot to ICS, we think it’s a good decision” .
“But we have to work at a very local level to make sure it works for local communities. And we have to make sure the highs don’t become too dominant.
He acknowledged that the reforms had been “driven by the NHS”, but added that “what we have is probably the best opportunity we could have had – otherwise it was going to be dictated to [us].”
He added that there was “still a bit of flexibility” in the July 1 target date for ICS.