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NHS and local government leaders have raised concerns over the ‘considerable uncertainty’ surrounding the accountability and governance arrangements of integrated care systems (ICSs), which are set to cover the whole of England by April 2021.

Lack of clarity over roles and relationships, confusion over the interaction between ICS objectives and existing statutory duties, and uncertainty over the role and significance of ‘place’ are among concerns highlighted in a new report from the NHS Confederation’s ICS Network and Solace.

Delivering together: developing effective accountability in integrated care systems spotlights the views of senior leaders on how system accountability should develop. It follows a roundtable discussion in October 2019 which explored health and care systems’ ‘internal’ accountability, their accountability to national arm’s-length bodies and government, and accountability to local communities.

“Participants reported a lack of clarity over aspects of ICS ‘internal’ accountability, including the role of constituent organisations, the relationship of constituent organisations’ statutory roles to ICS roles, and the relationship of ICSs to health and wellbeing boards,” the report argues.

“In addition, there is a sense that there are too many circular conversations about governance, and too many national and regional meetings to discuss  ICS accountability. These can seem to be an exercise in anxiety management, rather than serving a specific and local purpose,” the report goes on to say.

Based on the discussion, which featured senior NHS and local government leaders, the report makes a number of recommendations, including:

• ICSs should agree a clear set of shared outcomes for the system to deliver and which form the basis of robust mutual accountability
• ICSs should be “smart, ambitious, translational systems” that are “confident enough not to need to ask for permission, but able to ask for forgiveness if necessary”
• ICSs’ local system plans should set the agenda for conversations with arm’s-length bodies and regulators about how and where systems will make a difference
• the NHS Long Term Plan should be viewed as one component of a broader based local strategy for improving the health and wellbeing of the local population
• primary care networks and integrated care partnerships should be used to drive forward an agenda of improving the lives of local people. However, they should not be “smothered” by attaching too many objectives to them at an early stage
• health and care systems should operate as systems of “managed difference” (rather than “postcode lottery”), with appropriate local and national accountability arrangements to support this.

Download the report to find out more.

The NHS Confederation’s ICS Network, launched in November 2019, is one of a number of activities the organisation is undertaking to support local systems. Find out more about the network.