How can ICBs deliver for people against these four aims?

GGI’s director of consultancy Mason Fitzgerald highlights how GGI can help ICBs to balance their focus in the year ahead.

GGI has analysed the governance of all 42 of the country’s integrated care boards (ICBs) and worked directly with 18 of them.

Our analysis, carried out as part of our partnership work with the NHS Confederation, was designed to assess the performance of ICBs against the four core aims of integrated care:

• improving outcomes in population health and healthcare
• tackling inequalities in outcomes, experience and access
• enhancing productivity and value for money
• helping the NHS to support broader social and economic development.

The central point of the four aims is to deliver health and wellbeing for people and communities in a way that addresses inequalities and improves outcomes. At the root of each aim is the issue of scarcity, which has always had a huge impact on life expectancy and quality of life.

And scarcity is what this year’s GGI Festival of Governance is all about. Good governance because scarcity is real. We’ll be staging events all over the country to showcase examples of people frugally innovating – using what they have and collaborating with others for the benefit of all of us.

We will learn a lot from each other – and from no one more than Jane Davidson, the winner of this year’s Good Governance Award, who will also be delivering our annual lecture. Jane has made her life’s work the frugal use of resources – whether they be financial, environmental, human or time.

Analysis findings

It has been said that integrated care boards (ICBs) have been ‘born into the mother of all storms’, with severe operational and financial pressures, industrial action and the potential for further structural changes all-consuming the time and energy of senior leaders.

Based on our work with clients, our analysis and discussions across a number of ICS network webinars, we have found that most ICBs have struggled to balance their focus across the four aims.

A summary of these challenges we have observed are set out in the table below:

Despite these challenges, there are examples of good practice, with ICBs having items linked to the wider determinants of health, inviting presentations from local authority and other partners, and using the development of system risk management to focus more on upstream risks.

Given the levels of scarcity in our society and its impact on population health and healthcare outcomes, more of this thinking and collaboration is needed in order to make the most of the limited resources available.

ICB board members are frustrated with the current position but remain committed and optimistic that they, working with partners and stakeholders, can make a difference to the lives of people in their local communities. The development of integrated care strategies now provides a stronger strategic framework for work across the four aims, and many ICBs are accelerating plans to delegate functions to provider collaboratives and place-based partnerships, which will enable decisions to be made closer to local communities.

The coming months will be crucial for ICBs to implement these plans and realise their ambition. We therefore set out six recommendations to help ICBs balance their focus across the four aims for the year ahead:

1. Ensure the joint forward plan sets out a clear delivery plan for the transformation and integration of services, linked to an agreed set of system outcomes.
2. Ensure the BAF reflects ‘upstream’ risks to strategic objectives, which will be driven by the wider determinants of health, and use the BAF to drive agenda items at committee and board.
3. Set out the ICB’s expectations for strategy development that incorporates the four aims, i.e.: People, Research, Green plan, Estates, and Engagement strategies should all support delivery of the four aims.
4. Develop existing reports to incorporate key metrics/outcomes that are broader than traditional healthcare reporting i.e.: population health outcomes, upstream and community-based indicators.
5. Review the effectiveness of ICB committees, ‘resetting’ the focus on strategic assurance against priorities and system outcomes, and ensuring population health and health inequalities are the golden thread running through all reports.
6. Use your end-of-year review to take stock and plan ahead for 2023-24, with particular focus on the issues set out above, including agreement of system outcomes, a refreshed board assurance framework and improved operation of the governance structure.