MPs call for improved funding certainty for ICSs

The committee this week published its report on the new system-based structure set up in the English NHS last summer. It said there was a lot of optimism and genuine enthusiasm for the new partnership approach.

However, the MPs raised a number of concerns that the new systems’ potential would not be realised, calling for NHS England and the Department of Health and Social Care to drop its ‘command and control’ approach. The centre should recognise the importance of local priorities. Any targets set by the centre should be based on outcomes. And ICSs should be free to decide how best to deliver those outcomes.

It called on the Department to publish its proposed shared outcomes framework as soon as possible and for more information about when ICSs should expect it to be implemented.

Systems have a clear remit to target population health and address health inequalities. But the committee said there was a danger that short-term acute pressures could dominate ICS capacity and resources.

Committee chair Steve Brine called on ministers ‘not to lose sight of the crucially important prevention agenda’ and ‘to adopt a light-touch outcome driven approach to this new way of working’. He referenced the Hewitt review, which is due to report shortly and is considering similar themes to the committee’s own inquiry. ‘We welcome the spotlight that is being shone on ICSs at this early stage in their development,’ he said. ‘We hope to see this focus maintained and look forward to considering the review’s findings.’

The report – Integrated care systems: autonomy and accountability – also called for systems to be supported in taking long-term decisions and given more certainty over funding rather than providing short-term funding pots. While additional funding for winter pressures was welcomed, the fact that the money was only provided for six months meant it was often not used optimally, with providers reluctant to bring new capacity on stream that will have to be removed at the end of March. In evidence, Patricia Hewitt, chair of Norfolk and Waveney Integrated Care Board, said that building modular capacity would be a better response, but this took five months and could not be done with money that only lasts for six months.

The committee also highlighted rigid rules and onerous reporting requirements that accompanied adult social care discharge funding provided over the winter. ‘While funding is therefore welcome, we note that the nature of its allocation and monitoring may lead to the unintended consequence of restricting the autonomy of ICSs,’ the committee said.

Sarah Walter, director of the NHS Confederation’s ICS Network, backed the call for ICS targets to be outcomes-based. ‘Although there is an understandable need to deliver improvements against some of the immediate priorities facing ICS, we would agree with the committee’s position that long-term improvements to care and health outcomes for communities will be dependent on ICSs having the capacity to focus on public health, prevention and their role in the local economy,’ she said.

And Miriam Deakin, director of policy at NHS Providers, added that outcome-based targets and allowing ICSs greater flexibility to agree local priorities would ‘enable them to better meet the needs of their communities – including addressing health inequalities.’

In its evidence to the inquiry, the HFMA said that a permissive framework for ICSs should involve multi-year revenue and capital allocations to avoid funding being received late in the year.