Guidance

Frequently asked questions (FAQs) on the integrated care partnership engagement document

Updated 20 September 2021

General

Who is this document for?

The primary audience for this document are the local authorities and designated ICB chairs and boards who have a statutory and equal responsibility for establishing ICPs from April 2022.

However, this engagement document will also be of interest to a whole range of stakeholders who work in local communities to provide health and social care and are critical to the success of ICPs. For example:

• local residents, including people who rely on care and support, and unpaid carers
• adult social care providers and associations
• health service providers, including the NHS and private providers
• Healthwatch
• the VCSE sector
• Criminal Justice System agencies

And many more individuals, agencies and providers across the sector.

What do we mean by ICPs?

In this document, we are explicitly talking about integrated care partnerships, which are one of the 2 core elements of integrated care systems (ICSs); the other being integrated care boards (ICBs). Integrated care partnerships (ICPs) are the statutory committee of the ICS. ICBs and local authorities are statutory members of the ICP and form an equal partnership. As statutory members, they are required in law to set up and run the ICP. ICPs can, and are encouraged to, form partnerships with a range of other stakeholders appropriate to the places they cover, by either inviting them to be members of the ICP committee or engaging with them in other ways.

The integrated care partnerships which are the focus of this document should not be confused with integrated care providers, which are sometimes also referred to as ICPs. Integrated care providers are one type of integration that we would expect the integrated care partnership to support but they are not the same thing.

What is a statutory committee?

It is a committee which legislation requires to be established. It is not a statutory body, unlike the ICB part of the ICS, which is a statutory body that will take on the current functions and budgets of CCGs.

Implementation and operations

What can ICPs be called?

We have not yet reached a formal position on the naming protocols for integrated care partnerships. We would appreciate views from stakeholders we are engaging with through this document and in any subsequent engagement.

When will ICPs need to be established?

The ICP is a core element of the new model and ICSs cannot be fully functional without an ICP. We therefore expect that all systems will have at least interim ICPs up and running when statutory ICBs commence as planned in April 2022. Specifically, we would expect an interim ICP to comprise a chair and a committee of at least representatives of the ICB and the relevant local authorities, and for there to be agreement over how the committee will be resourced.

However, we also recognise that there is an interdependency between the task of establishing the statutory ICB from April 2022 and establishing the ICP. In practical terms, the ICP will be established by the ICB and local authorities in an area jointly, so cannot by definition be formally established in some areas until the designated chair and chief executive of the ICB is in place, and possibly also the wider board of the ICB in some places. In a number of areas, NHS England have only just begun recruitment for these positions. This may mean that in some areas it may not be possible to formally agree the model for the ICP until later in 2021 or early 2022.

Further detail on next steps for implementation is included in the main document (section ‘Next steps’).

How will ICPs be resourced?

Designated ICB leaders and local authorities have a statutory responsibility to establish the ICP. It will therefore be up to these statutory partners of the ICP to agree how the ICP would be best resourced. They should consider the resources required to provide a secretariat function to the committee, develop and deliver the integrated care strategy and actively promote integration across the system.

Depending on the feedback we receive from stakeholders on this engagement document, we may share additional principles of good practice to be considering locally when agreeing the resourcing for ICPs. We would welcome engagement from systems and local government to co-develop these principles.

How will an ICP chair be elected?

Due to the shared role across the NHS and local government to establish the ICP and appoint the chair, we do not propose to formally define the appointments process. We would encourage ICB leaders and local authorities to review their existing processes for appointing an individual in public office and follow the principles of transparency, fairness and competence.

Depending on the feedback we receive from stakeholders on this engagement document, we may share additional principles of good practice to be considering locally when agreeing the appointment process for the ICP chair. We would welcome engagement from systems and local government to co-develop these principles.

Is there a job or person specification for ICP chairs?

There is no prescriptive person specification for ICP chairs. This should be agreed by the ICB and local authorities responsible for establishing the ICP and appointing a chair. Some of the key skills that we think will be important and should be considered when developing a person specification are:

• the ability to build and foster strong relationships in the system
• collaborative leadership style;
• commitment to innovation and transformation
• expertise in delivery of health and care outcomes
• the ability to influence and drive delivery and change

What are the salary requirements for ICP chairs?

It is up to ICBs and local authorities in an integrated care system to agree appropriate remuneration for the chair of the ICP. This will depend on the anticipated time commitment, whether the chair is already employed by an existing organisation in the system and other factors. The guidance given on the salary expectations for the ICP chair could be used as a basis from which to make this decision. The principle of parity of esteem and respect between the ICB and ICP should be considered when deciding an appropriate remuneration.

How will ICPs develop an integrated care strategy and make decisions?

ICPs should engage with a range of stakeholders to develop their integrated care strategy and make decisions. This engagement could take the form of membership on the statutory committee or other forms of informal partnership that will be equally critical to the process of co-production at the heart of ICPs.

Decisions should be based on evidence of what works, local data and insights from people with lived experience of health and social services. There is an expectation that ICBs will share available data on broad health and social issues, and the determinants of health outcomes, in a timely manner to inform decisions and strategy developing. ICPs should also take account of existing HWB strategies and JSNAs.

Depending on the feedback we receive from stakeholders on this engagement document, we may share additional principles of good practice to be considering locally when agreeing the decision making process for ICPs. We would welcome engagement from systems and local government to co-develop these principles.

Relationships in the ICS

How will ICBs and local authorities have accountability within ICPs?

ICBs and local authorities are both statutory members of the ICP and form an equal partnership, reflecting their joint responsibility to establish the ICP. As members, ICBs and local authorities will be directly involved in the development of the integrated care strategy and the priorities which it seeks to deliver.

ICBs and local authorities will work together through ICPs to meet cross-cutting priorities for which they are all responsible, alongside other ICP partners. The duty of equal partnership between ICBs and local authorities on ICP committees should bring them together and support an ongoing and dynamic form of shared accountability.

What are the differences between ICPs and HWBs?

Health and wellbeing boards (HWBs) are legislated for at place level, bringing together the NHS, local authorities and wider partners to develop strategies for places and Joint Strategic Needs Assessments (JSNAs) for their populations. These are mandatory requirements and essential for improving the health and wellbeing of local populations at the place level.

ICPs, on the other hand, are designed to support partnerships and integrated working across places, at system level, specifically looking at broad health and care experiences and outcomes that cannot be solved by one organisation or place alone.

What is the relationship between ICPs and HWBs?

The relationship between an ICP and HWBs in an area will differ from place to place depending on the scope and number of the HWBs, their maturity and existing partnership arrangements. ICPs should complement the ongoing activities of HWBs by promoting integration from the place-level to the system-level. HWBs will have local and place-based insight that will be incredibly valuable to the ICP when looking at and developing a strategy to address cross-cutting, long-term health and care challenges.

Can a HWB act as an ICP?

No, but ICPs should consider how existing governance arrangements, such as HWBs, could provide the opportunity to build greater alignment between different partners and the community, and ensure effective, joined-up decision-making. For example, in smaller systems, where the majority of ICS governance will be conducted at the system level, partners might agree to common membership of the ICP and the HWB and streamline arrangements for holding meetings. This may allow different sets of business to proceed in a more coordinated way.

In other systems, which vary in size, set up, and area, ICPs should consider how best to bring HWBs as strategic partners. For example, this could be through a single or multiple representatives from HWBs within the ICP’s area. Local areas are free to do this however they see best, with the ultimate goal being to strengthen the relationship to places and enhance the ICP’s connection to what people and communities need.

What is the relationship between ICP and place-based partnerships?

ICPs should work closely with place-based partnerships to support and promote integrated working from the place to the system level. Place-based partnerships and ICPs will bring together similar statutory and non-statutory partners but ICPs should focus on collecting the experiences and expertise of these partners to address health and care challenges that span across places and organisations. These challenges include improving health and care outcomes and experiences for local populations, and reducing health inequalities by targeting some of the determinants of poor health and wellbeing such as poverty, worklessness and the impacts of climate change.

How will ICPs engage with the public?

ICP’s will be transparent and accountable to the local community, by meeting in public with minutes and papers available online.

In order to bring independent insight, expertise in engagement, and constructive challenge to ICPs from a community perspective, we have legislated to recognise the important role that Healthwatch will play (Section 116ZB of the Local Government and Public Involvement of Health Act 2007, will be amended by clause 20 of the Health and Care Bill).

In addition, we expect ICPs to go further. Whether sitting as committee members or on advisory panels, we expect the people and communities of every system to be fully involved in all aspects of the development of the ICP integrated care strategy. We expect ICPs to set out how it has involved, engaged and listened to local people and explained how they have acted in response to these views.

This is a minimum requirement. We expect ICPs to develop proposals for engagement with people in their areas which ensure that their plans and strategies deliver what people need and expect.

How will the ICPs ensure the representation of all of those in the local community?

ICPs should ensure that they have diverse and inclusive representation of the local communities which the system serves. At Annex C we have provided an illustrative list of the partners that ICPs could appoint to the statutory committee or engage with in other creative and collaborative ways. We welcome thoughts on additions to this list.

We have also emphasised in this engagement document that ICPs should be dynamic and evolve as the needs of local communities change and partnerships mature. Representation should change in line with this to ensure the ICP remains relevant to the populations they are responsible for and the priorities they have set for themselves.

What will the relationship between democratic governance processes and the ICP structure look like?

Local authorities are a statutory member of ICPs and will have a critical role to play. Namely, bringing a broad range of social and care issues and insights to the attention of the ICP, and delivering on the integrated care strategy to improve the services local authorities are responsible for.

We recognise that local authorities will need to meet their democratic duties and will sometimes have specific democratic priorities. Given the equal status of the partnership between the NHS, local authorities and the community, the integrated care strategy should support any democratic priorities that have an impact on health and care and cannot be addressed by just one part of the system.

The mutual accountability of partners within ICPs should also complement the existing accountability mechanisms that exist within the democratic processes of local authorities.

Where issues do arise, these should be dealt with in an open and transparent way, and communicated with the ICB where appropriate.

What role do we expect non-statutory and statutory partners, other than the NHS and local authorities, to play in ICPs?

The ICP is founded first and foremost on the principle of equal partnership between the NHS and local government in delivering services. This means the founding basis of each ICP is an equal partnership between the 2 components which have statutory responsibility for meeting health and care needs.

This does not mean the NHS and local authorities are the only and most important parts of any system; ICPs must recognise the vital contribution of both statutory and non-statutory partners in delivering great outcomes for people. Adult social care providers, for example, have a central role to play in delivery social care and improving experiences and outcomes, as do communities and unpaid carers. In keeping with the wider theme of the proposals, local areas will have the flexibility to design the best solution for them, but we would expect each ICP to adopt a model of representation which reflects the diversity of the local provider sector and ensures meaningful engagement with providers of all shapes and sizes.

We will be engaging with systems, providers and provider representatives over the coming months to develop best practice on the role of the social care provider sector, voluntary, community and social enterprises sector and other partners within ICPs.

What happens if the ICP cannot agree a plan within the terms of the MOU?

If an ICP cannot agree a plan this would indicate a serious failing within that system and require urgent action to ensure the needs of the population are being met.

This would, in the first instance, be a failure to fulfil a statutory duty on the part of both the ICB and the local authorities involved, which would trigger potential intervention powers on the NHS side.

In order to fulfil their statutory duty, we would expect the ICB and local authorities to come together urgently to resolve the issue and if that did not work there are a number of mechanisms available:

• peer review process – the ICS might want to enlist support from leaders in other ICSs to enable them to resolve the issue
• support from NHS England regional or national teams to unblock the issue
• support from the LGA
• national intervention where necessary in the case of failure

Ultimately this would be a failure to discharge statutory responsibilities and would need to be addressed as a matter of urgency.

How will conflicts of interest be managed?

Leaders from the relevant ICBs and local authorities should use their existing protocols for managing conflicts of interest as a basis from which to build a policy for ICPs. Provision is made in the Health and Care Bill in relation to conflicts of interests and ICBs. We can consider this further, including the expectations on non-local authority and non-ICB members, as part of our engagement process.

Will any follow-up documentation be published?

We will be engaging with systems, providers and provider representatives over the coming months to develop best practice briefings on the role of statutory and non-statutory partners.

If needs to be, we will develop example frameworks for the structuring on ICP’s and other supporting documentation.