1 July 2022 - Non-executive directors - The day has arrived... the new ICS world

Marking the ‘momentous’ day that England’s 42 ICSs moved to a statutory footing, GGI senior consultant Mason Fitzgerald opened this week’s discussion by introducing GGI senior associate Philippa Slinger, former CEO of various community and mental health trusts and former chief executive at Devon STP.

Philippa said: “For NHS trusts the world has become a very interesting place – particularly since the guidance around place and the desire for subsidiarity and the delegation of functions and activities to place. Because of course place as a construct doesn’t exist. It’s a planning arena. To put some sort of hard teeth around place there needs to be some sort of legal form. In the NHS there are only two forms that can be: the ICS, through a sub-committee arrangement, or a trust taking on some lead hosting role if it’s going to take a delegated budget and function. As trusts and ICSs begin to think about that, we’re seeing increasingly a movement of people wanting to delegate both functions and budget to place – to give place the power it needs to create integrated services – but with that vehicle behind it of an NHS organisation. The question is: what opportunity does that create for the NHS trust that’s going to ‘host’ the place-based arrangements?

“What it means is that instead of just being an NHS organisation that cares for and tries to do its best for it patients, it must do its best for the entire population, of which some will be patients. That’s a very different outlook for NHS organisations. So how do you transform your organisation and culture to one that not only looks after patients as well as it possibly can, but also does its absolute best to make certain that it reduces the number of people in its population that become patients. Or reduces the level of disability that those individuals with chronic disease may live with so there are less people to care for in the future.

“So, boards and executive teams have a lot to start thinking about. And if you take on a commissioning function within this and become some sort of subcontractor for other organisations, then there’s a whole range of activity to be thought about.

“There’s also the opportunity to collaborate with other NHS trusts and other organisations in the system so you can transform pathways across not just your place but across other places and maybe across ICSs. We shouldn’t forget the opportunity that supra-ICS collaborations between organisations may offer for cardiac pathways and cancer pathways – we see that in the cancer networks now – so there are more opportunities to leverage those things. I see this as a great opportunity, and I wish everyone the best of luck.”

Mason shared a checklist for success for ICSs (available in the attached slide deck), highlighting a few items on the checklist for further discussion.

On vision and strategy, he said: “The ICB and NHS trusts are required to jointly develop five-year forward plans. In legal terms ‘jointly’ is a very strong word, binding you all together. What does that mean for your trust board? Does it mean the trust doesn’t need its own strategy because it’s a delivery vehicle for the ICB strategy? Also, as providers who know your populations really well, how can you influence and lead that planning across the system, so it’s focused and right for the people in your populations?

“There’s also a legal duty to have regard of the wider effects of decisions you make. You need to think from today about the impact of what you’re doing on the health and wellbeing of populations, and the impact on other organisations in your system. At your next board meeting, how will you be assured you’ve taken the necessary steps in your organisation?

“We’ve also noticed a slight underestimation from NHS trusts about what they might be taking on in terms of delegated budget and commissioning functions. It’s really important that the whole suite of commissioning functions is properly understood and thought about before taking that leap.”

Turning to system oversight and risk, Mason said: “There’s a slight concern that the arrangements at different levels will add another layer of assurance. There’s a huge opportunity to push back and ensure that assurance arrangements in place are as streamlined as possible. That gives you the headspace and time to do the innovation and improvement that’s needed to address health inequalities and improve outcomes.”

On board development and operation, he said: “How do you have oversight as a board on the wider determinants of health? How do you have oversight of some of the drivers of demand for services, whether that’s access to primary care or housing, employment etc?”

Also overheard during the discussion:

“Given all the concerns there are about staff vacancies, and the way there’s a sense of duplication of senior executive leaders working within the system and at provider level, what steer is there about how we adjust our people policies?”

“The first question you need to ask is: have you got the skills, capability and capacity in your executive team to do everything? You need a different skillset to work in a collaborative system compared with running a hospital. There should be no expectation that you take on additional responsibilities without receiving further resources.”

“The system oversight framework has 72 metrics that everyone’s measured against and not many are related to the wider determinants of health – it still has a very traditional NHS focus.”

“The 'one workforce' principle should be extended into our communities. We should see our local communities as our recruitment base for the future i.e. 'grow our own' and 100% ensure that all communities are supported into work.”

Click here to download the slides used by Mason Fitzgerald during this webinar.

These meetings are by invitation and are open to all NHS non-executives directors, chairs and associate non-executive directors of NHS providers. Others may attend by special invitation.

If you have any comments, questions or suggestions about these webinars, please contact: events@good-governance.org.uk