A Report by the Director of Care and Health set out the policy context for the development of Integrated Care Systems (ICS) in the NHS in England, specifically highlighting the work to create a Cheshire and Merseyside ICS. The report also set out the emerging guidance around developing Integrated Care Partnership (ICP) in “ place” and specifically in Wirral.

The report set out the policy context as follows:

·  26 November 2020 -  NHS England/ Improvement (NHSE/I) published integrating Care: Next steps to building strong and effective integrated care systems across England, subsequently referred to as Integrating Care: Next steps

·  11 Feb 2021 – The Department of Health and Social Care (DHSC) published the White Paper Integration and innovation: working together to improve health and social care for all. On the same day NHSE/I issued four documents encouraging Her Majesty’s Government to introduce legislation, at the earliest opportunity to place Integrated Care Systems (ICSs) “ on a clear statutory footing, but with minimum national legislative provision and prescription, and a maximum local operational flexibility”.

·  25 March 2021 – NHS England and NHS Improvement published the NHS Operational Planning and Implementation Guidance for 2021/22, setting out that:

·  There will be one statutory ICS NHS body and one statutory ICS health and care partnership per ICS from April 2022. •

·  Clinical Commissioning Group (CCG) functions will be subsumed into the ICS NHS body and some NHS England and NHS Improvement direct commissioning functions will be transferred or delegated to ICSs.

·  CCG staff below board level who are directly affected will have an employment commitment and local NHS administrative running costs will not be cut as a consequence of the organisational changes.

·  Through strong place-based partnerships, NHS organisations will continue to forge deep relationships with local government and communities to join up health and social care and tackle the wider social and economic determinants of health. To enable this, ICS boundaries will align with upper-tier Local Authority boundaries by April 2022, unless otherwise agreed by exception. Joint working with local government will be further supported by the health and care partnership at ICS level.

·  The development of primary and community services and implementation of population health management will be led at place level, with Primary Care Networks as the building blocks of local healthcare integration.

·  Every acute (non-specialist) and mental health NHS trust and Foundation Trust (FT) will be part of at least one provider collaborative, allowing them to integrate services appropriately with local partners at place and to strengthen the resilience, efficiency and quality of services delivered at-scale, including across multiple ICSs.

·  Clinical and professional leadership will be enhanced, connecting the primary care voice that has been a strong feature of Primary Care Networks (PCNs) and CCGs, to clinical and professional leadership from community, acute and mental health providers, Public Health, and social care teams.

The report further advised that the intention of the Government to bring forward a Health and Care Bill to implement the proposals in the White Paper was announced in the Queen’s Speech on 11 May 2021 and the main elements of the bill are:

·  Driving integration of health and care through the delivery of an Integrated Care System in every part of the country.

·  Ensuring NHS England, in a new combined form, is accountable to Government, Parliament and taxpayers while maintaining the NHS’s clinical and day-to -day operational independence.

·  Banning junk food adverts pre-9pm watershed on TV and a total ban online.

·  Putting the Healthcare Safety Investigation Branch on a statutory footing to deliver a fully independent national body to investigate healthcare incidents, with the right powers to investigate the most serios patient safety risks to support system learning.

The report then set out how Integrated Care Systems will be developed with reference to guidance published by the NHSE/I on 16 June 2021 setting out future ambitions for:

·  the functions of the ICS Partnership to align the ambitions, purpose, and strategies of partners across each system.

·  the functions of the ICS NHS body, including planning to meet population health needs, allocating resources, ensuring that services are in place to deliver against ambitions, facilitating the transformation of services, co-ordinating and improving people and culture development, and overseeing delivery of improved outcomes for their population.

·  the governance and management arrangements that each ICS NHS body will need to establish to carry out those functions including the flexibility to operate in a way that reflects the local context through place-based partnerships and provider collaboratives.

·  the opportunity for partner organisations to work together as part of ICSs to agree and jointly deliver shared ambitions.

·  key elements of good practice that will be essential to the success of ICSs, including strong clinical and professional leadership, deep and embedded engagement with people and communities, and streamlined arrangements for maintaining accountability and oversight.

·   the key features of the financial framework that will underpin the future ambitions of systems, including the freedom and mechanisms to use resource flexibly to better meet identified needs and to manage financial resources at system level.

·   the roadmap to implement new arrangements for ICS NHS bodies by April 2022 to establish new organisations, appoint leadership teams to new statutory organisations and to ensure that people affected by change are offered a smooth transition that allows them to maintain focus on their critical role in supporting recovery from the pandemic.

It was further reported that the Cheshire and Merseyside Integrated Care System (ICS) had established a Development Advisory Group (DAG) to support the implementation timetable and guidance. The Chief Executive and the Director for Adult Care and Health, Wirral Council and the Chief Officer, NHS Wirral CCG are part of the DAG. Members were advised that there is also representation from Wirral in other ICS governance arrangements such as the Partnership Board and joint committee of Cheshire and Merseyside Clinical Commissioning Groups.

The report set out an implementation timetable that the ICS is working to that is subject to the Health and Care Bill becoming an Act of Parliament.

Members were advised that In regard to developing Integrated Care Partnerships (ICPs) in each place, the Cheshire and Merseyside ICS had set out seven expected core features of an ICP:

· ICP Governance – clearly defined formal arrangements for place partners to meet and work together to deliver outcomes set by the Health and Wellbeing Board (HWB) and ICS.

· ICP nominated ‘Place Lead’ with remit for integrated working who will connect with the ICS.

· Shared vision and plan for reducing inequalities and improving outcomes of local people approved by the HWB (underpinned by local population health and socio[1]economic intelligence).

· Agreed ICP development plan.

· Defined footprints (e.g. neighbourhoods) for delivery of integrated care, clinically led by PCNs working with social care, community, mental health, Public Health, and other community groups.

· Programme of ongoing public and wider stakeholder engagement at place

· Integrated approach to commissioning between health and Local Authority (such as shared posts, joint teams, and pooled budgets) to underpin and support the work of the ICP. The seven expected core features are described in more detail in Appendix 2. 3.3.9 Work has commenced in Wirral to create an Integrated Care Partnership involving the Local Authority, NHS and wider partners in health and care. The work is being guided by six core principles:

· Organise services around the person to improve outcomes.

· Maintain personal independence by providing services closest to home.

· Reduce health inequalities across the Wirral population.

· Provide seamless and integrated services to patients, clients, and communities, regardless of organisational boundaries.

· Maximise the “Wirral £” by the delivery of improvements in productivity and efficiency through integration.

· Strengthen the focus on wellbeing, including a greater focus on prevention and Public Health.

There are four key work streams in the development of an ICP for Wirral. These are:

· Integrated governance, including Health and Wellbeing Board development.

· Developing provider collaboration.

· Developing integrated commissioning.

· Communications and engagement.

In response to comments from Members in regards to the complexities of the ICS developments it was suggested that an all member workshop be arranged to best inform all members of the Council of developments.

Resolved That:-

(1)  The report be noted;

(2)  further written reports on the progress of the development of the Integrated Care System and Integrated Care Partnerships at future meetings be received; and

(3)  an all member workshop be held to best inform members of the Council of developments.