Integrated Care Boards

Question

Asked by

To ask Her Majesty’s Government how they are monitoring and assessing the transition of Clinical Commissioning Groups to Integrated Care Boards; and how the success and impact of the new structure will be evaluated and reported to Parliament.

Integrated care boards took over the role of commission and secondary care services from clinical commissioning groups on 1 July 2022. NHS England formally oversees these ICBs, and it has a legal duty to assess annually the performance of each ICB and to publish its findings. CQC system assessments will also provide an independent assurance to the public and Parliament. The success and impact of these new arrangements will be measured by a DHSC-commissioned evaluation completed by academics.

My Lords, there are key factors to providing successful health and social care services that are outside the control of integrated care boards but very much within the control of the Government, including workforce supply and investment in social care capacity. Could the Minister tell the House how the impact of government provision will be measured and, where necessary, what action will be taken to put this right so that ICBs are actually able to deliver quality joined-up services for local people?

As the noble Baroness will be aware, a lot of the work at the local level will be done by the ICBs, in partnership with others, under the ICS system. On the Government’s role on workforce, the department commissioned Health Education England to produce a report to look at the long-term strategic drivers to support long-term workforce planning. This work is nearing its final stages. We have also commissioned NHS England and NHS Improvement to develop a long-term workforce plan for the next 15 years. In addition, as the noble Baroness will know, Section 41 of the Health and Care Act 2022 gives the Secretary of State a duty to publish a report at least every five years.

My Lords, can my noble friend the Minister say whether the importance of civil society to these care boards is realised? It is often local charities that really know what is going on in a community, and it is really important that they are involved going forward.

My noble friend makes a really important point on this: if you look at the structure at the local level, you will see the ICBs, but they are in partnership with civil society organisations and others to form the ICP. The integrated care boards and integrated care partnerships together comprise the integrated care system locally. When looking at local health needs and the health of populations, particularly in deprived areas, it is really important that we work with local charities and civil society organisations; they are quite often trusted more by local people than professionals.

My Lords, I know the Minister agrees that the NHS depends very heavily on efficient and effective social care services being available to it. Could the Minister tell the House whether he is satisfied that, throughout the country, local social care services will be involved in these new arrangements from the outset and as equal partners?

During the debate on the Health and Care Bill, which became the Health and Care Act, one of the things on which we agreed across the House was that each integrated care board should have the appropriate mix of skills. I think that was thanks to an amendment by the Liberal Democrats. This particular issue shows that we need to ensure that we are considering all the important aspects of health. One of the things that will be very important is the parity of mental health with physical health. All these issues will be considered at the local partnership level.

My Lords, one of the key elements of ensuring there is a good transition is the procurement process. Last month, three CCGs were fined for using considerable organisational bias to ensure that their contracts went to a preferred company. The fine must be paid by the ICB, and the staff from the CCG are now in the ICB. What are the Government going to do to ensure that this sort of practice is monitored and ruled out by the new bodies as they get under way?

I hope the noble Baroness will remember that, during the debate on the Health and Care Bill, there were concerns about private sector bias, as it were, in giving contracts. We agreed to an amendment suggesting that there should be no conflict of interest. I am afraid I am not aware of the specific cases that the noble Baroness raises, but I will look into them and write to her.

Does the Minister agree that yet another reorganisation of the management structure of the NHS is irrelevant to the latest problem facing the NHS, which is the dramatic loss of staff? We are losing thousands every month. That is where we should be focusing our efforts—does he not agree?

One of the challenges that we all face, and that the system as a whole faces, is that, even though we have more doctors and nurses than ever before, demand is outstripping the supply of healthcare workers. One reason for that is that there are far more conditions that would not have been considered years ago. Therefore, the Government, in partnership with the NHS, are looking at particular issues—for example, retention of the workforce, where they are worried about their pensions, and making social care an attractive vocation, with training and skills, as well as looking to recruit people, as we did after the war. As I often remind noble Lords, it was people from the Commonwealth who saved our health service after the war, and when we do not have the skills locally we will look to recruit people from abroad.

I understand from a senior ICB medical member that doctors expect general practice to be in the position that dentistry is in today in a bit of time. In other words, access to a GP will depend on the ability to pay. That is incredibly serious—it is the end of the NHS as we have known it, free at the point of delivery and need. Will the Minister take back to his colleagues the absolutely essential point that the Government must ask the ICBs to prioritise the assessment of general practice in their areas and to develop a strategy to ensure that general practice continues to be free at the point of need?

The noble Baroness makes the point about general practice. One thing that we are looking at, which will probably come up in the debate later in the week on the future of primary care, is the whole issue of what GPs do. There are many things they do that they do not have to do—these could be done by local partners, practice nurses, physiotherapists or social prescribing, and so on. In addition, Ministers and the NHS have been in conversation with GPs’ representatives, looking at these particular issues.

My Lords, could my noble friend update the House on the scheme for bringing in overseas workers to fill the gaps in social care that have opened up so seriously over the last year or two? There have been suggestions that the salary level—which currently does not allow sufficient numbers of care workers to come into the UK, when they are desperately needed—might be lowered. Is there any update for the House on that?

I thank my noble friend for the question. The last I was aware of—and I shall look at it and write to my noble friend—was that, under the visa scheme, we were looking to bring in people from overseas to fill those vacancies. We have historically done that; as I said, after the war we looked to people from the Commonwealth, who came and saved our public services. Clearly, when we are unable to recruit enough people locally, we have to look at those issues and at whether it is something to do with the education system, and whether we can encourage them to come forward. But where there are gaps we will have to look more widely to our partners around the world.

My Lords, when the Minister took the Bill through the House, he argued that a restructuring was necessary to integrate services, yet outside every acute hospital dozens of ambulances are stacked up every day, often waiting for hours with patients inside, because we have a disintegrated system. Can he show me what the integrated care boards are doing today to end that dreadful practice?

One priority of my right honourable friend the Secretary of State—I think he is still the Secretary of State—has been to look at the ambulance system. On a wall in his office, he has all the various things; he has talked to various partners and he has brought people together to see what the problems are, why we are unable to unload patients into hospitals, what the blockages are and how we can address this from a systemic view.

My Lords, the recent Civitas report put the UK second from bottom in patient outcomes in key areas of cardiovascular disease, cancer and a reduction in life expectancy. Can the Minister say what role commissioning should play in improving patient outcomes?

On patient outcomes, the noble Lord is quite right: we need to look at the statistics—where we are doing well and where we are not doing so well—and then focus efforts at not only the national level but the local ICB level, to make sure there is the appropriate commissioning. Indeed, one responsibility of the local integrated care board is to look at what services are needed in the local area and make sure that they are commissioned.