What is an Integrated Care System?

You may have heard about local healthcare arrangements changing, with the Government insisting a shift towards ICSs (Integrated Care Systems). So, what are they, and why are they important?

Local NHS services will be run by the new integrated care system, the Sussex Health and Care Partnership, from 1 July this year, when the new Health and Social Care Act comes into force.

The new pan-Sussex partnership will be governed by an Integrated Care Board (ICB), and thanks to pressure from Labour Councillors, Brighton & Hove City Council have ensured they will have representation on this board.

Our Council will be represented by a senior officer, and by Cllr Shanks as Chair of the Health & Wellbeing Board, although her position will be a non-voting one.

What will this all mean in practice, and what are the main areas of concern?

One of Labour’s serious concerns around the ICS is that it has the potential to lead to backdoor privatisation. Even though we have some faith in the local arrangements we have in Brighton & Hove, we’re aware of the pressure they could come under from the highly centralised, ‘command and control’ national structure of the NHS, to give way to privatisation, if that is the will of the government at the time. Therefore, we think it’s crucial to ensure safeguards are in place locally. That includes having a voice on the board, and having democratic oversight.

We want to ensure local arrangements have as much democratic accountability and oversight as possible. Thanks to an amendment from the House of Lords, the Health and Care Act does now allow for local authority representation on ICS boards. Whilst neighbouring Conservative Councils chose not to pursue this, we felt strongly it was important to have an elected representative on the board.

We voiced these strong feelings to the Green administration ahead of the recent Policy & Resources Committee meeting, and they shared our concerns. This is one of the reasons the report was pulled and brought back to an Urgency Sub-Committee a week later, to give the administration more time to fight for representation on the board. Fortunately, they were successful, and we’ve been given an extra place for the Chair of Health & Wellbeing Board, although this will be a non-voting place which is less fortunate.

The report itself that came to the Urgency Committee was thin on the ground in terms of detail, both in terms of what’s actually happening next, and what form some of the emerging local structures will take, as these have not been finalised yet. We believe the cross-party Member Working Group we have asked for can help to influence those very structures, and put Councillors on them to give residents a voice, and that it can also help flesh out the next steps and support our Director of Health and Social Care to deliver the best outcomes for the people of our city.

Other concerns we have relate to the financials surrounding the ICS. We haven’t seen a budget for this yet, and would be very concerned about joint decisions being made about the local authority’s Adult Social Care budget, and those decisions not coming to members in good time for proper scrutiny. Especially at a time when residents are paying more and more in council tax and ASC precept year on year in the midst of a cost of living crisis that has seen inflation hit it’s highest levels in 40 years. Democratic oversight and scrutiny of the finances is crucial, as it is local ratepayers money at stake.

We want the opportunity to scrutinise local healthcare spend, particularly in relation to preventative care services and public health, which we know are the key areas we need to invest in if we are to address the health inequalities in our city. According to the most recent (pre-pandemic) Joint Strategic Needs Assessment, men in the most deprived parts of the city will live around 10 years less than men in the least deprived parts of the city. The differential in women is around 7.5 years. That’s around a decade difference in life expectancy between areas like East Brighton and a 20-30 minute bus ride away to areas like Hove Park. We welcome the emphasis on public health in the report, but we need democratic oversight to ensure that is delivered on, because for a relatively small city, the health inequalities that exist are striking in Brighton & Hove and must be addressed.

What’s next?

We understand that these arrangements will are due to be under review in 12 months, and we will certainly push to ensure a review takes place. We are confident that our Labour Health Overview Scrutiny Committee team will watch the coming months very closely, and on behalf of residents, identify areas for review and improvement.

Why is democratic oversight so important?

Ultimately, a range of factors including public finances, creeping backdoor privatisation, and health inequalities, mean it is crucial that there is as much democratic oversight and accountability of the ICS as possible – and that is what we are trying to achieve.

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Image: Creative Commons