Guidance

Integrated care partnership (ICP) engagement document: integrated care system (ICS) implementation

Updated 20 September 2021

Foreword

The Department for Health and Social Care (DHSC), NHS England and NHS Improvement (NHSEI) may update or supplement this document during 2021 to 22. Elements of this document are subject to change until the legislation passes through Parliament and receives Royal Assent. We also welcome feedback from system and stakeholders to inform our guidance to the system and learn from implementation. The latest versions of all NHS England and NHS Improvement guidance relating to the development of integrated care partnerships (ICSs) can be found at ICS guidance.

Summary

This engagement document is focused on the role of integrated care partnerships (ICPs) within statutory arrangements for integrated care systems (ICSs). It has been jointly developed by the Department of Health and Social Care, NHS England and NHS Improvement and the Local Government Association (LGA).

The government has brought forward proposals in its Health and Care Bill to implement statutory arrangements for ICSs with 2 components. The first component is the integrated care partnership, or ICP: a broad alliance of organisations and representatives concerned with improving the care, health and wellbeing of the population, jointly convened by local authorities and the NHS. The second component is a statutory body, the integrated care board, or ICB: the ICB will be responsible for the commissioning of healthcare services in that ICS area, bringing the NHS together locally to improve population health and care.

This document focuses on the role of ICPs within systems. ICPs are a critical part of ICSs and the journey towards better health and care outcomes for the people they serve. The ICP will provide a forum for NHS leaders and local authorities to come together, as equal partners, with important stakeholders from across the system and community. Together, the ICP will generate an integrated care strategy to improve health and care outcomes and experiences for their populations, for which all partners will be accountable.

Given the important role of ICPs within ICSs, this early engagement document is intended to help systems prepare to establish ICPs from April 2022, subject to the passage of the Health and Care Bill through Parliament. This publication also formally initiates a process of co-production and engagement to identify examples of good practice. These examples will be informed by the insights of local authorities, NHS leaders and others who have already developed non-statutory arrangements for ICSs, built on the strong partnership arrangements in place in many areas.

This document builds on NHS England and NHS Improvement’s (NHSEI) ICS design framework to provide more detail on the role of ICPs, the statutory framework, guiding expectations and the timing of implementation. We have also provided a list of FAQs which we hope address stakeholders’ immediate questions. On questions that we have not yet been able to provide an answer to, we hope stakeholders will engage with us to co-produce a set of principles to inform and guide systems in their efforts to implement ICPs.

The document sets expectations and explores possibilities for ICPs, rather than dictating precisely how ICPs should work. This is in line with the permissive and flexible approach DHSC are taking to the Bill as a whole.

Purpose of this document

This document aims to present a vision for ICPs to lay the foundations for strong, well-equipped partnerships which will be required to take a holistic and place-based view of health and care.

The first step in a wider engagement process, this document builds on the principles for ICPs set out in NHSE’s ICS design framework (published on 16 June 2021). We aim to:

• offer further detail on what we see as the role of, and opportunities for, ICPs as one of 2 core elements of ICSs
• provide further explanation around the statutory framework for ICPs, as legislated for by the Health and Care Bill
• set out the guiding expectations we have for ICPs in their operation and delivery
• give stakeholders more clarity on timings for establishment of ICPs and how this fits with the establishment of other elements of the system

This document is not a one-size-fits-all guide of how to set up and run ICPs, nor do we intend to provide that. While we may publish further guidance in response to the implementation questions this document may raise, we aim to retain the flexible, permissive and enabling approach which underpins our legislative proposals to allow local systems to take the decisions on what will work best in their areas.

This engagement document should be read alongside wider ICS guidance being issued by the NHS on ICB establishment, as well as any further guidance, good practice and implementation resources on ICPs that may be issued as a result of engagement following this publication.

The intended audience of this document are stakeholders responsible for establishing ICPs from April 2022; that is, local authorities and designated ICB chairs and boards. It should provide helpful framing to consider what arrangements might work best in their areas and reach agreement on resourcing and management for the ICP.

This document will also be of interest to stakeholders who are critical to the success of ICPs. This includes, but is not limited to:

• 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 voluntary and community enterprise sector (VCSE)
• criminal justice system agencies

And many more organisations with a vested interest and role in supporting the design and delivery of health and care services.

Our intention is for this document and any future guidance to generate conversations between ICPs and their chairs to help each other learn and develop up until April 2022 and beyond. This document and resulting engagement will be a contribution to a process of system-based learning and improvement rather than a repository of rules or instructions. The ‘Next steps’ section of this document provides more information about how best to engage with this process.

Introduction

The success of the health and care system in meeting the health and care needs of the community depends on many factors, but the response to the COVID-19 pandemic clearly demonstrates the importance of joined up approaches to strategy development and decision-making across the system and communities. During the pandemic, we saw the brilliance and dedication of the health and care workforce enhanced by the strengthening of existing, and development of new, partnerships. The pandemic also highlighted the critical dependencies in health and care, including areas which are sometimes ‘less high profile’ but equally as important, such as community and voluntary services, the role of unpaid carers, employers and employment support services.

People who work in health and care are strongly motivated to make a difference to individual patients or clients, and population health. There is now a widespread understanding of the need to make connections and work in partnership with other agencies to address the wider social determinants of health. This approach has been demonstrated locally, for some time, as different professionals and organisations work together to address long-term challenges such as population changes, health inequalities and the management of complex, chronic conditions. However, partnerships of this kind are not yet being seen everywhere or for everything.

The pursuit of ‘integration’ is about ensuring that the right partnerships, policies, incentives and processes are in place to support practitioners and local organisations to work together to help people live healthier and more independent lives for longer. ICPs will play a critical role in making this happen.

The establishment in law of an integrated NHS and local authority model for ICSs places ICPs on a statutory footing, building on existing partnerships and collaboration across the whole system. As a statutory committee, ICPs will a) be required to be established in every system; b) have a minimum membership required in law (the ICB and local authorities); and c) will be tasked with producing an integrated care strategy for their areas. The legislation has been framed in a deliberately permissive way, and this is particularly true for ICPs. There are several models already being developed as ICSs have evolved and there is a real opportunity for different systems to learn from one another as ICSs develop. We see this variation as a strength and, therefore, want to avoid constraining innovation and encourage iterative learning through the legislation or guidance.

ICPs will have a critical role to play in ICSs, facilitating joint action to improve health and care outcomes and experiences across their populations, and influencing the wider determinants of health, including creating healthier environments and inclusive and sustainable economies. They will consider what arrangements work best in their local area by creating a dedicated forum to enhance relationships between the leaders across the health and care system. For example, the NHS, local government, adult social care, employment support, and VCSE coming together to build a culture of partnership and broad collaborations to promote and support holistic care.

ICPs’ central role is in the planning and improvement of health and care. They should support place-based partnerships and coalitions with community partners which are well-situated to act on the wider determinants of health in local areas. ICP should bring the statutory and non-statutory interests of places together.

ICPs will be required to develop an integrated care strategy to address the broad health and social care needs of the population within the ICP’s area, including determinants of health such as employment, environment, and housing issues. ICBs and local authorities will be required by law to have regard to the ICP’s strategy when making decisions, commissioning and delivering services. Further opportunities to enable the alignment of ICBs, local authorities and ICPs through guidance are being explored and we welcome views on this.

The ICP is expected to highlight where coordination is needed on health and care issues and challenge partners to deliver the action required. These include, but are not limited to:

• helping people live more independent, healthier lives for longer
• taking a holistic view of people’s interactions with services across the system and the different pathways within it
• addressing inequalities in health and wellbeing outcomes, experiences and access to health services
• improving the wider social determinants that drive these inequalities, including employment, housing, education environment, and reducing offending
• improving the life chances and health outcomes of babies, children and young people
• improving people’s overall wellbeing and preventing ill-health

Stakeholders have told us that they would value the space to develop joint strategies to better serve local populations, based on population health management approaches. ICPs will enable partners to plan for the future and develop strategies for using available resources creatively in order to address the longer-term challenges which cannot be addressed by a single sector or organisation alone.

These strategies should reflect the priorities of all partners, particularly regarding wider determinants of health and encourage connections between different parts of the system and community. Strategies should recognise both the complexity and opportunity to deliver improved health and care outcomes and experiences in this way.

The ICP should complement place-based working and partnerships, developing relationships and tackling issues that are better addressed on a bigger area. As part of the development of ICSs, we expect places to play a central role in population health management, the planning and improvement of health and care, joined up service provision, and to build broader coalitions with community partners to promote health and wellbeing. The principle of subsidiarity should be a driving force to ensure that decisions are taken by communities at the most appropriate geography.

Context and background

The department’s white paper Integration and innovation: working together to improve health and social care for all, published in February 2021 set out the proposal for an ICP Committee within statutory arrangements for ICSs. This was informed by engagement around NHSEI’s paper Integrating care: next steps to building strong and effective integrated care systems, published in November 2020.

The discussion around NHSEI’s publication considered how best to embed 2 key aspects of integration – across the NHS and with the wider system (between the NHS, local government and other partners). Both types of integration are crucial if systems are to meet the broad ambitions of the ICS to improve health and care outcomes, tackle health inequalities and promote a preventative approach to health, as well as delivering the right care, at the right time, in the right place, when it is needed.

Everyone across the health and care system has a responsibility to support, promote and deliver the collective aims of the ICS, including more joined up approaches where that is in the best interests of their populations. The 2 structures working across the system geography – the ICB and ICP – have complementary but distinct responsibilities which should be drawn out.

The ICB will be a key mechanism to secure collaboration within the NHS, and at the interface of health and local government. It will hold the NHS bodies within the ICB’s area to account and ensure the NHS is an effective and relevant partner in the place it operates.

The ICP will support broad and inclusive integration across places and driving meaningful improvements in cross-cutting health and care outcomes and experiences. The ICP will provide a forum for agreeing collective objectives, enable place-based partnerships and delivery to thrive alongside opportunities for connected scaled activity to address population health challenges.

More detail about the role of, and opportunities for, ICPs is detailed below.

Principles of ICPs

NHSEI’s ICS design framework set out the shared vision for ICSs, including both the ICP and the ICB elements. The framework was developed in collaboration with a wide range of stakeholders and recognises that while the ICB (sometimes referred to as the ‘ICS NHS body’) is a statutory NHS Body, the ICP has a different status and role. Both are equally important and complementary components of the ICS.

The ICP will work, first and foremost, on the principle of statutorily equal partnership between the NHS and local government to work with and for their partners and communities. Depending on the makeup of the system and the distribution of responsibilities, local government might include district and borough councils, as well as county and unitary councils. The focus of the ICP will be on building shared purpose and common aspiration across the whole system.

With this as the framing objective, NHSEI’s ICS design framework sets out key principles for ICPs (see Annex A). local authorities and designated ICB chairs and boards should meet in the ICP as co-owners and equal partners of that committee, using the principles in the framework to guide the establishment of ICPs, their culture and ways of working.

Opportunities for ICPs

As set out in NHSEI’s ICS design framework, we do not intend to produce prescriptive guidance for ICPs. ICPs will be a dynamic element within every system, building on the assets that already exist in the community and wider system, and adapting as populations and priorities change, and relationships develop over time.

The creation of ICPs presents an enormous opportunity to:

• build on existing governance structures such as health and wellbeing boards (HWBs) and other place-based partnerships, and support newly forming structures to ensure governance and decision-making are proportionate, support subsidiarity and avoid duplication across the ICS
• drive and enhance integrated approaches and collaborative behaviours at every level of the system, where these can improve planning, outcomes and service delivery
• foster, structure and promote an ethos of partnership and co-production, working in partnership with communities and organisations within them
• address health challenges that the health and care system cannot address alone, especially those that require a longer timeframe to deliver, such as tackling health inequalities and the underlying social determinants that drive poor health outcomes, including employment, reducing offending, climate change and housing
• continue working with multiagency partners to safeguard people’s rights and ensure people are free from abuse or neglect and not deprived of their liberty or subject to compulsory detainment or treatment without safeguards
• develop strategies that are focused on addressing the needs and preferences of the population including specific cohorts (such as babies, children and young people; or ageing populations)

The opportunities outlined above aim to help facilitate discussion between local authorities and ICB chairs and boards responsible for setting up ICSs, with local systems, as arrangements are established and best practice can be shared.

Mandatory requirements for ICPs

The Health and Care Bill sets out several mandatory requirements for local authorities and ICB boards and chairs. See Annex B for these requirements and accompanying explanatory notes.

The Bill sets out more detail on ICBs than on ICPs because in addition to new functions and responsibilities set out in legislation and in NHSEI policy, statutory functions similar to those currently exercised by CCGs are expected to be conferred on ICBs, which means that legislation needs to define key areas of their governance function. The ICP is a statutory committee of the ICS, not a statutory body, and as such its members can come together to take decisions on an integrated care strategy, but it does not take on functions from other parts of the system.

DHSC has chosen to minimise the level of prescription around ICPs in the primary legislation. Experience has shown us that systems are most effective when there is a national framework that provides guidance and ensures consistency, while allowing for maximum local flexibility in how they operate and design themselves to meet local needs over time. There will, however, be a duty to cooperate on the ICB and local government.

On membership of ICPs, we have taken a minimalist approach. The only members specified are the ICB and local authorities in an ICS area, who must come together to establish the ICP. Wider membership should be locally determined, although we expect ICPs to be, at the very least, a partnership between the NHS, local authorities and wider community.

The Bill also says the ICP must “involve the local Healthwatch organisations whose areas coincide with or fall wholly or partly within its area, and the people who live or work in that area”. Further suggestions on the scope of membership and engagement are included in Annex C, although local areas will have greater familiarity with the agencies, providers and individuals who would make an effective contribution to the partnership. While it is important for the ICP to engage with a wide range of stakeholders and have an understanding of the differing viewpoints across the system and communities, membership should be kept to a productive level.

Delivering action through partnership may well involve a wide range of partners, however, not all partners need to be a member of the ICP. Stakeholders can be actively engaged in a number of ways such as, sub-committees or dedicated workshops.

The Bill states that the ICP’s integrated care strategy should have regard to the NHSEI Mandate and any guidance issued by DHSC, and explicitly covers the issue of integration and the use of Section 75 arrangements, including pooled funds. Although not specified in the Bill, the strategy should also consider a joint workforce plan, including the NHS, local government, social care and VSCE.

The Bill is clear that areas do not have to prepare a new strategy if existing joint health and wellbeing strategies are considered sufficient by NHS, local authority and community partners. For example, if existing strategies set out a vision for improving population health and wellbeing outcomes, through integrated services and commissioning plans, this might be considered sufficient. This establishment of statutory arrangements for ICSs is to build on what is already working in the system and community and working together to make improvements, where possible.

While stakeholders have welcomed the flexibility afforded by the Bill’s permissive approach to ICPs, we recognise that it may be helpful for the statutory requirements to be bolstered by a set of clear but broad expectations to support the establishment of ICPs.

Through this engagement process we want to explore what a good strategy might look like (recognising that there may be several different models), supported by good practice examples, with a view to informing future guidance if needed.

Guiding expectations for ICPs

DHSC, NHSEI and the LGA have jointly developed the expectations set out below. These are intended to help local authorities and designated ICB chairs and boards maximise the value that ICPs that can give back to local communities. They complement and build on the principles for ICPs set out in NHSEI’s ICS design framework.

The 5 expectations are:

1. ICPs are a core part of ICSs, driving their direction and priorities.
2. ICPs will be rooted in the needs of people, communities and places.
3. ICPs create a space to develop and oversee population health strategies to improve health outcomes and experiences.
4. ICPs will support integrated approaches and subsidiarity.
5. ICPs should take an open and inclusive approach to strategy development and leadership, involving communities and partners to utilise local data and insights.

The next section builds on each of these and describes in more detail how we expect the ICP to add value in these areas.

ICPs are a core part of ICSs, driving their direction and priorities

ICPs will be influential, driving forces within ICSs, fostering partnerships, and using their leverage to ensure ICBs and local authorities have regard to the integrated care strategy. ICPs’ strategies will be ambitious, challenging and enable all partners to integrate, innovate and deliver ever improving outcomes and experiences, drawing on the knowledge, skills and experiences of the people and communities they serve. In many areas, strong partnerships are already functioning, and where this is the case, we expect these to be the basis for this statutory committee.

The roles of the ICP and the ICB are distinct and complementary in supporting the objectives of the ICS. The ICB is an organisation designed to align the planning and operation of NHS care and is accountable for NHS expenditure. The ICP is where the ICB, local authority, and wider community come together. It is a forum for wider system partners to agree shared objectives, work on joint challenges, and support places and organisations that comprise the system in the interests of communities. To create the dynamic relationship and collaborative leaderships between ICBs and ICPs that will be critical to the success of ICSs as a whole, and already exists in some areas, we expect:

• ICBs and local authorities will establish the ICP and be statutory members, in partnership with wider system stakeholders
• ICSs will ensure the constitution and governance of the ICB and ICP is aligned, and agreed by local government and other partners
• partners responsible for delivering the priorities of the ICP’s integrated care strategy – for example, ICBs, local government and other stakeholders – will also be members of the ICP and therefore able to hold each other to account
• ICBs and local authorities will have regard for the ICP’s integrated care strategy when developing their plans and priorities and should consider how assurance can be provided to the ICP on delivery.
• ICBs, local authorities and other partners should share intelligence with the ICP in a timely manner to ensure the evolving needs of the local health service are widely understood and opportunities for at scale collaboration are maximised.
• leadership and accountability are important in the relationship between ICBs and ICPs. Some ICSs may choose to appoint a single chair of the ICP and ICB or draft a joint strategy and plan. Others may choose to have 2 chairs. Our model for ICSs is designed to harness the differing experiences and perspectives of critical partners that make up the ICP so that they can agree a shared agenda, for the benefit of the local population

ICPs will be rooted in the needs of people, communities and places

We expect ICPs to be strongly connected to the places within their ICS area through co-production with their communities, strong citizen engagement and strategies informed by data and evidence. We know that places vary by population and geography, as well as the history and strength of the connections between the agencies that and services that provide joined up care.

To help places continue to improve outcomes and experiences of their communities, we want to build on the fantastic work already being done at place level and encourage decisions to be taken as close as possible to, and where appropriate involving, the communities and people they affect. We have therefore balanced what is prescribed by legislation with what should rightly be left to local decisions.

The Bill builds in an important role for HWBs at place level, which will remain legally distinct from ICPs. ICSs (both the ICB and the ICP) will be required to take account of HWB strategies and Joint Strategic Needs Assessment (JSNA) in developing their plans, to avoid duplication of effort. This should ensure that ICP strategies are rooted in a strong understanding of the places and communities they serve. Both HWBs and ICPs can be flexible in their membership and system roles to best suit local circumstances and to be complementary to one another and the ICB and local authorities.

To further embed place in the long-term health and care strategies that are developed, as a minimum, we would expect ICPs to have:

• input from directors of public health, through arrangements agreed by local authorities in the ICS area, and other clinical and professional experts (including primary, community and secondary care) to ensure a strong understanding of local needs and opportunities to innovate in health improvement
• input from representatives of adult and children’s social services – for example by at least one director of adult social services or director of children’s services agreed by the local authorities in the ICP area. Input from local social care providers will also be needed
• relevant representation from other local experts, through HWB chairs, primary or community care representatives and other professional leads, for example in social work and occupational therapy
• appropriate representation from any providers of health, care and related services
• appropriate representation from the VCSE sector, including of social care, as well as representatives from people with lived experiences of accessing health and social care services in the ICS area, including children and young people
• a representative from Healthwatch to bring senior level expertise in how to do engagement and to provide scrutiny

It is not a requirement for all of these stakeholders to be ‘members’ of the ICP committee. The key is that opportunities for co-production and expert input into ICP strategies are available, this could be through sub-committees or dedicated public meetings, for example.

To bring independent insight, expertise in engagement, and constructive challenge to ICPs from a community perspective, we recognise the important role that Healthwatch will play (Section 116ZB Health and Care Bill). Local Healthwatch organisations have an existing statutory presence in places, bringing together views of local residents to inform decision making at, for example, HWBs and scrutiny committees. ICSs should build on this, working with local Healthwatch organisations to resource the coordination and analysis of user experience data. ICSs should also draw on the expertise of Healthwatch to engage harder to reach communities and collaborating with voluntary and community sector. This will offer unique insight when tackling issues such as health inequalities. We expect the people and communities of every system to be fully involved in all aspects of the development and delivery of the ICP integrated care strategy. We expect each ICP to set out how it has involved, engaged and listened to local people and explain how it has acted in response to these views.

To embed the link to people, communities, and places, ICPs should also 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 in HWBs as strategic partners. For example, this could be through a single or multiple representatives from HWBs within the ICP’s area. This should be determined locally, with the goal being to strengthen the relationship to places and meet the needs of local people and communities.

ICPs create a space to develop and oversee strategies to improve health and care outcomes

ICPs will set priorities for improving system-wide health and care outcomes and experiences for everyone, while also championing the principle of subsidiarity and empower local decision making. The ICP and place-based partners will need a mechanism to determine which issues are dealt with where; most issues can be best dealt with at place and these should not be decided at ICP meetings.

ICP priorities should be informed by local population wants and needs, and specific communities identified through population health management data. ICPs should consider how they can better work together in and across place-based partnerships to deliver these priorities. Place-based partnerships may bring together similar partners to ICPs but target funding or attention at a certain place in order to tackle specific issues or deliver local services. ICPs will support existing ICS aims to improve health by building on the strategies and actions in which partners are already engaged, for example through the HWBs or committing to new and more innovative models of delivery. ICPs will create a forum in which partners should hold each other mutually to account for delivering the priorities set out in its integrated care strategy, including over the longer term. Practical examples of how this accountability could be exercised by ICPs and local systems may be included in future documents.

Many systems are proactively exploring upstream prevention initiatives and looking for further partnership opportunities to support people to improve their overall health and care outcomes. We want ICPs to enhance the work that is underway to support this positive shift.

ICPs will promote the mobilisation of resources and assets in the community and system, and across place-based partnerships; for example, by joining up existing services and the efforts of unpaid carers to provide more streamlined pathways of care which are more efficient and for the benefit of the community. This mobilisation of assets should look beyond the traditional boundaries of anchor institutions such as the NHS in finding solutions, and share these solutions with the ICB and local authorities, who will be responsible for funding and operationalising delivery. We expect the approach to be led by local data and evidence of what works, as well as co-production with system and community representatives.

Owing to the breadth of health, regulatory, public protection and social care responsibilities and functions that are held by local authorities, they have a rich repository of experience and expertise (for example, through directors of public health) in how to understand population needs and improve outcomes and experiences. The ICP should bolster this understanding with the insights that can be gained from engagement and collaboration with the VCSE and wider agencies and community groups, who bring a fresh perspective to service delivery. This is particularly important for to finding innovative solutions to improving outcomes for the most vulnerable and groups with the poorest health, for example through social prescribing or other approaches.

ICPs will support integrated approaches and subsidiarity

ICPs will be in a unique position to identify opportunities for wider partnerships to strengthen our collective approach to improving longer-term health and wellbeing outcomes. For example, across education, housing, environment, transport, employment, and community safety; these wider social determinants of health, and others, have a significant bearing on the health and wellbeing of communities and health inequalities, particularly for people experiencing deprivation-poverty. We expect ICPs to actively champion integrated approaches and look for opportunities to embed and accelerate these in their strategies. This is a key aim of ICSs as a whole.

ICPs will set the strategic direction and workplan for organisation, financial, clinical and informational integration, as well as other types. For example:

• shared vision and purpose
• integrated provision – so that people receive seamless care across health, social care, housing, education and other public services (including those delivered by independent providers), and between different NHS providers
• integrated records – for example using shared electronic care records for non-clinical and back-office functions as well as NHS services
• integrated strategic plans – for example, bringing NHS and public health experts together to make a joint plan for improving health outcomes in their area. This could complement or form part of the ICP mandatory responsibility to produce an integrated care strategy
• integrated commissioning of services – strengthening the partnership between local authorities and the ICB to enable them, and other partners, to work together in areas such as mental health, learning disability, autism, older people, public protection and reducing offending where there are health considerations
• integrated budgets – and the delegation of functions into places, supporting the principle of subsidiarity and facilitating integration. For example, using Section 75 arrangements to manage or support pooled budgets across the NHS and local authorities or in place-based partnerships for children or adults
• integrated data sets – which all partners can contribute and have access to in order to inform planning and the delivery of services for the benefit of communities

ICPs will champion integration across the ICP area but most integrated provision will happen at place. In these cases, we would expect ICP plans to build on that by facilitating opportunities to deliver more integration at place and system and share innovation and expertise in how to deliver integrated approaches in the context of local circumstances. ICPs will need to be aware of and engaged with the work already being undertaken at place and the strategies that have been drawn up by HWBs, system people boards and other relevant system structures. They should not seek to overrule or replace existing place-based plans.

It will be up to ICPs to work with HWBs and other place-based partnerships to determine the integrated approach that will best deliver holistic and streamlined care in their communities. This might be achieved through more clinical integration, integrated commissioning or more budget pooling, all facilitated by joined up working. Further guidance on the duty to co-operate will be issued at a later date to support ICPs and the wider system in meeting this expectation.

ICPs should take an open and inclusive approach

The ICP will have a key leadership role to play in setting the tone and culture for each system. An ICP must operate a collective model of accountability, where partners hold each other mutually accountable, including to local residents, and this should be set out in each ICP’s integrated care strategy. The culture should champion co-production, diversity, equality and inclusiveness, recognising that the challenges they are trying to solve are complex, and require input from a range of people, include community associations and residents themselves. Leaders should set this culture and focus on joint working and collaboration.

The needs and wishes of people, communities and service users are the foundation of everything the ICP is trying to deliver. Therefore, ICPs should develop a structured, and meaningful, approach to co-production with people with lived experience and consider accountability of their approach. It will also be important to draw on the experience and expertise of professional, clinical, social, political and community leaders and promote strong system leadership.

This inclusive approach should create a productive learning system within and beyond the ICS, and include engagement, co-production and sharing of quantitative and qualitative evidence collection and analysis. In doing so, ICPs should be open and engaging, agreeing arrangements for transparency and local accountability, including meeting in public with meaningful minutes and papers being made easily accessible.

Timings and establishment of ICPs

In this section, we set out some statements of expectation around timings and responsibilities for establishing ICPs.

The ICP is a core element of the statutory arrangements for ICSs which cannot be fully functional without an ICP. We therefore expect that all systems will have at least an interim ICP up and running when statutory ICBs commence as planned in April 2022, subject to the passage of the Health and Care Bill through Parliament. Specifically, we would expect an interim ICP to comprise a chair and a committee of at least statutory members (the ICB and local authorities), and for there to be agreement on how the committee will be resourced. Local authorities will not have access to any additional funding to support the ICP but should agree with their health counterparts how best to provide the necessary secretariat and other functions vital to the partnership.

To longer timeframes, sub-committee structures, linkages with other governance structures and period changes to ICP membership could be agreed. The process of formation of the ICP will have a large effect on its success: the approach taken at the early stages of development therefore needs to be inclusive and iterative – open to different perspectives and willing to adapt.

We 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 ICB designated chair and chief executive of the ICS is in place, and possibly also the wider board of the ICB in some places.

In a number of areas, NHSEI has now begun recruitment for these positions; however, it will not be possible to formally convene the ICP before the ICB has been established. This is why we recognise that in some areas there may be an interim ICP in April 2022, but we would expect local authorities and existing ICS leaders, to be discussing with key partners and exploring options for how they want their ICPs to work, to enable swift progress once legislative provisions come into place. In some areas this will be about adapting existing partnerships to form the ICP, in some places this may be a HWB and in others, existing system level structures may form a starting point from which to base the ICP.

Similarly, from April 2022, it is possible that some ICPs may have draft strategies and others may be relying on existing Health and Wellbeing strategies. We expect the work of developing, refining and formally agreeing a complete integrated care strategy to continue after April as this will need to involve significant engagement in the local area. The strategy will also need to take account of existing JSNAs produced by HWBs in their places. We recognise that this level of engagement may require more time than is available between now and April 2022.

Regarding membership, some ICPs may have established the membership from April 2022, while others still in their interim form may still be building their membership. We hope that all ICPs will be able to build their membership to a steady state by September 2022. This will be a key enabler for ICPs to fully develop their integrated care strategy. We expect ICPs to operate with transparency, and it should be clear to all partners and the public how and when (frequency) membership will be reviewed and agreed

We do not propose to set national expectations for the appointment or remuneration of the ICP chair beyond stating that this should be a fair and transparent process adhering to the normal expectations of appointing public positions and agreed by the ICB and local authorities. Additional principles of good practice may be shared in the process of system engagement. We also do not intend to prescribe a person specification for the role of ICP chair, although as a minimum, we would expect the person appointed to:

• be able to build and foster strong relationships in the system
• have a collaborative leadership style
• be committed to innovation and transformation
• have expertise in delivery of health and care outcomes
• be able to influence and drive delivery and change

Next steps

This document seeks to energise systems as they begin to consider what ICP arrangements would work best in their areas. It is intended to build on NHSE’s ICS design framework to enable ICSs to prepare the foundations of their ICPs to deliver on the objectives. Utilising the forum that the ICP creates to enhance the social, economic and environmental conditions within systems and communities will be fundamental to improving health and wellbeing for all.

We intend to use this document as the start of a conversation with systems and communities on the development and evolution of ICPs. This will include, but not be limited to, engaging with the local authorities and NHS leaders responsible for establishing for ICPs on:

• whether the expectations set out in this document achieve the right level of ambition
• how local authorities and NHS leaders see themselves delivering on these expectations
• what might challenges or obstacles leaders might face in establishing ICPs
• how ICPs will work with HWBs and others to bolster place-based partnerships
• what other guidance, information or engagement might be needed in order to support the establishment of their ICPs
• what a good integrated care strategy might comprise

As well as engaging with systems as they work on the establishment of their ICPs, we intend to engage with wider partners and communities on:

• what their hopes and expectations are for ICPs
• how they would like to be engaged in ICPs
• whether there are any specific matters they would like to see clarified in guidance for ICPs

We hope to use these conversations to co-produce a repository of FAQs and case studies in how different areas are approaching the establishment of ICPs, which we can share more widely over the coming months. We aim to look at both best practice examples and how to address more challenging circumstances in our case studies, offering a framework for systems to resolve any issues themselves.

We will also be considering the potential for formal, statutory guidance to inform the development of ICP strategies going forward.

This engagement with systems and communities will help develop the direction of travel for ICPs, and we also hope, build a repository of case.

Practical steps for implementation

We now ask all 42 integrated care systems to take the following 5 steps (please note the indicative dates). We ask the NHS ICB Chairs Designate to ensure these steps are carried out in their system, in partnership with local government.

1. Recognise that it is for the NHS and local authorities – as the statutory partners in each ICS – to start the process jointly of creating an ICP in preparation for legislation (September 2021).
2. Reach agreement between NHS and local authority leaders as to how the ICP will be established and a secretariat resourced, at least during the 2021 to 2022 transition year (October 2021).
3. Ensure that the statutory ICP partners come together as required to oversee ICP set up, including engagement with stakeholders (November 2021).
4. Appoint an ICP chair designate, taking account of national guidance on functions and ensuring there is a transparent and jointly supported decision-making process (February 2022).
5. Determine key questions to be resolved for that particular system including but not limited to the following (April 2022):

• What kind of chair would best galvanise the system behind its common aims and what is the process for appointment?
• Who might constitute an ICP committee that might galvanise the ICS and how should those individuals be chosen?
• What would be required to deliver an inclusive approach to engagement, in terms of methods, resourcing, and public reporting?
• To what extent can existing structures be used or adapted to create the ICP so as to build on what happens already?
• To what extent do existing ICS plans meet the requirement for a health and care strategy and how might they be refreshed?
• How might the ICP meet the 10 principles described in NHSEI’s ICS design framework to set the culture of the system?

Annex A: the ICS partnership – extract from the NHSE design framework

Each ICS will have a partnership at system level established by the NHS and local government as equal partners. The partnership will operate as a forum to bring partners – local government, NHS and others – together across the ICS area to align purpose and ambitions with plans to integrate care and improve health and wellbeing outcomes for their population.

The partnership will facilitate joint action to improve health and care services and to influence the wider determinants of health and broader social and economic development. This joined-up, inclusive working is central to ensuring that ICS partners are targeting their collective action and resources at the areas which will have the greatest impact on outcomes and inequalities as we recover from the pandemic.

We expect the ICS partnership will have a specific responsibility to develop an ‘integrated care strategy’ for its whole population using best available evidence and data, covering health and social care (both children’s and adult’s social care), and addressing the wider determinants of health and wellbeing. This should be built bottom-up from local assessments of needs and assets identified at place level, based on Joint Strategic Needs Assessments. We expect these plans to be focused on improving health and care outcomes, reducing inequalities and addressing the consequences of the pandemic for communities. We expect each partnership to champion inclusion and transparency and to challenge all partners to demonstrate progress in reducing inequalities and improving outcomes. It should support place and neighbourhood-level engagement, ensuring the system is connected to the needs of every community it includes.

The government has indicated that it does not intend to bring forward detailed or prescriptive legislation on how these partnerships should operate. Rather the intention is to set a high-level legislative framework within which systems can develop the partnership arrangements that work best for them, based on the core principles of equal partnership across health and local government, subsidiarity, collaboration and flexibility.

The ICS partnership will be a committee, rather than a corporate body.

To support this process, formal guidance on ICS partnerships will be developed jointly by the Department of Health and Social Care (DHSC), NHS England and NHS Improvement, and the Local Government Association (LGA), and consulted on ahead of implementation, including on the role and accountabilities of the chair of the integrated care partnership.

This document gives an overview of the type of information that we expect to be included in that guidance.

Establishment and membership

The partnership will be established locally and jointly by the relevant local authorities and the ICS NHS body, evolving from existing arrangements and with mutual agreement on its terms of reference, membership, ways of operating and administration. Appropriate arrangements will vary considerably, depending on the size and scale of each system. Members must include local authorities that are responsible for social care services in the ICS area, as well as the local NHS (represented at least by the ICS NHS body).

Beyond this, members may be from HWBs, other statutory organisations, voluntary, community and social enterprise (VCSE) sector partners, social care providers and organisations with a relevant wider interest, such as employers, housing and education providers and the criminal justice system (including courts, probation, and prison services).

They should draw on experience and expertise from across the wide range of partners working to improve health and care in their communities, including ensuring that the views and needs of patients, carers and the social care sector are built into their ways of working.

The membership may change as the priorities of the partnership evolve. To facilitate broad membership and stakeholder participation, partnerships may use a range of sub-groups, networks and other methods to convene parties to agree and deliver the priorities set out in the shared strategy.

Leadership and accountability

The ICS NHS body and local authorities will need to jointly select a partnership chair and define their role, term of office and accountabilities. Some systems will prefer the partnership and ICS NHS body to have separate chairs. This may, for instance, provide greater scope for democratic representation. Others may select the appointed NHS ICS body chair as the chair for both the NHS board and the partnership to help ensure co-ordination. This will be a matter for local determination.

We expect public health experts to play a significant role in these partnerships, specifically including local authority directors of public health and their teams who can support, inform and guide approaches to population health management and improvement, with directors of public health having an official role in the ICS NHS bodies and the partnership.

Partnerships will need clear and transparent mechanisms for ensuring strategies are developed with people with lived experience of health and care services and communities, for example including patients, service users, unpaid carers and traditionally under-represented groups, such as people in touch with the criminal justice system. These mechanisms should draw on best engagement practice; for example, by using citizens’ panels and co-production approaches, including insights from place and neighbourhood engagement.

Partnerships should build on the expertise, relationships and engagement forums that already exist across local areas, building priorities from the bottom up, to ensure the priorities in the strategy resonate with people across the ICS. As a key forum for convening and influencing and engaging the public, the partnership will need to be transparent with formal sessions held in public. Its work must be communicated to stakeholders in clear and inclusive language.

Partnership principles

The ICS partnership will play a key role in nurturing the culture and behaviours of a system.

We invite systems to consider these 10 principles:

1. Come together under a distributed leadership model and commit to working together equally.
2. Use a collective model of decision-making that seeks to find consensus between system partners and make decisions based on unanimity as the norm, including working though difficult issues where appropriate.
3. Operate a collective model of accountability, where partners hold each other mutually accountable for their shared and individual organisational contributions to shared objectives.
4. Agree arrangements for transparency and local accountability, including meeting in public with minutes and papers available online.
5. Focus on improving outcomes for people, including improved health and wellbeing, supporting people to live more independent lives, and reduced health inequalities.
6. Champion co-production and inclusiveness throughout the ICS.
7. Support the ‘triple aim’ (better health for everyone, better care for all and efficient use of NHS resources), the legal duties on statutory bodies to co-operate and the principle of subsidiarity (that decision-making should happen at the most local appropriate level).
8. Ensure place-based partnership arrangements are respected and supported, and have appropriate resource, capacity and autonomy to address community priorities, in line with the principle of subsidiarity.
9. Draw on the experience and expertise of professional, clinical, political and community leaders and promote strong clinical and professional system leadership.
10. Create a learning system, sharing evidence and insight across and beyond the ICS, crossing organisational and professional boundaries.

Annex B: statutory requirements and explanatory notes

The Health and Care Bill was presented before Parliament on 6 July 2021 and contains the following provisions on ICPs (note: all provisions in the Bill are still subject to Parliamentary approval. The latest version of the text can be found on the Parliament website):

Clause 20 (integrated care partnerships and strategies)

(1) The Local Government and Public Involvement in Health Act 2007 is amended in accordance with subsections (2) to (6).

(2) In section 104 (interpretation: partner authorities), in subsection (2), for paragraph (ja) substitute— “(ja) an integrated care board;”.

(3) In section 116 (health and social care: joint strategic needs assessments)— (a) in subsection (4), for paragraph (b) substitute— “(b) each of its partner integrated care boards,”; (b) after subsection (5) insert— “(5A) The responsible local authority must give a copy of each assessment of relevant needs prepared under this section to any integrated care partnership established under section 16ZA whose area coincides with or includes the whole or part of the area of the responsible local authority.”; (c) in subsections (6) and (7), for “clinical commissioning group”, in each place it occurs, substitute “integrated care board”; (d) in subsection (8), for “clinical commissioning groups” substitute “integrated care boards”; (e) in subsections (8A) and (9), for “clinical commissioning group”, in each place it occurs, substitute “integrated care board”.

(4) After section 116 insert— “116ZA integrated care partnerships (1) An integrated care board and each responsible local authority whose area coincides with or falls wholly or partly within the board’s area must establish a joint committee for the board’s area (an “integrated care partnership”). (2) The integrated care partnership for an area is to consist of— (a) one member appointed by the integrated care board, (b) one member appointed by each of the responsible local authorities, and (c) any members appointed by the integrated care partnership. (3) An integrated care partnership may determine its own procedure (including quorum). 116ZB Integrated care strategies (1) An integrated care partnership must prepare a strategy (an “integrated care strategy”) setting out how the assessed needs in relation to its area are to be met by the exercise of functions of— (a) the integrated care board for its area, (b) NHS England, or (c) the responsible local authorities whose areas coincide with or fall wholly or partly within its area. (2) In preparing a strategy under this section, an integrated care partnership must, in particular, consider the extent to which the needs could be met more effectively by the making of arrangements under section 75 of the National Health Service Act 2006 (rather than in any other way). (3) In preparing a strategy under this section, an integrated care partnership must have regard to— (a) the mandate published by the Secretary of State under section 13A of the National Health Service Act 2006, and (b) any guidance issued by the Secretary of State. (4) In preparing a strategy under this section, an integrated care partnership must— (a) involve the Local Healthwatch organisations whose areas coincide with or fall wholly or partly within its area, and (b) involve the people who live or work in that area.

(5) An integrated care partnership may include in a strategy under this section a statement of its views on how arrangements for the provision of health-related services in its area could be more closely integrated with arrangements for the provision of health services and social care services in that area.

(6) Each time that an integrated care partnership receives an assessment of relevant needs under section 116(5A) it must— (a) consider whether the current integrated care strategy should be revised, and (b) if so, prepare a revised integrated care strategy under subsection (1).

(7) An integrated care partnership must— (a) publish each integrated care strategy, and (b) give a copy of each integrated care strategy to— (i) each responsible local authority whose area coincides with or falls wholly or partly within its area, and (ii) each partner integrated care board of those responsible local authorities. In this section— (a) “assessed needs”, in relation to the area of an integrated care partnership, means the needs assessed under section 116 in relation to the areas of the responsible local authorities so far as those needs relate to the integrated care partnership’s area; (b) “partner integrated care board”, in relation to a responsible local authority, has the same meaning as in section 116; (c) “health services”, “health-related services” and “social care services” have the same meaning as in section 195 of the Health and Social Care Act 2012.” (5) In section 116A (health and social care: joint health and wellbeing strategies)— (a) in the heading, after “joint” insert “local”; (b) for subsections (1) and (2) substitute— “ (1) This section applies where a responsible local authority and each of its partner integrated care boards receive an integrated care strategy under section 116ZB(7)(b). (2) The responsible local authority and each of its partner integrated care boards must prepare a strategy (“a joint local health and wellbeing strategy”) setting out how the assessed needs in relation to the responsible local authority’s area are to be met by the exercise of functions of— (a) the responsible local authority, (b) its partner integrated care boards, or (c) NHS England. (2A) But the responsible local authority and its partner integrated care boards need not prepare a new joint local health and wellbeing strategy if, having considered the integrated care strategy, they consider that the existing joint local health and wellbeing strategy is sufficient.”; (c) in subsection (3)— (i) for “clinical commissioning groups” substitute “integrated care boards”; (ii) after “the extent to which the” insert “assessed”; (d) in subsection (4)— (i) for “clinical commissioning groups” substitute “integrated care boards”; (ii) before paragraph (a) insert— “(za) the integrated care strategy prepared under section 116ZB,”; (e) in subsections (5) and (7), for “clinical commissioning groups” substitute “integrated care boards”; (f) in subsection (8), for paragraph (a) (including the “and” at the end) substitute— “(a) “partner integrated care board”, in relation to a responsible local authority, has the same meaning as in section 116, (aa) “assessed needs”, in relation to the area of a local authority, means the needs assessed in relation to its area under section 116, and”. (6) For section 116B substitute— “116B Duty to have regard to assessments and strategies (1) A responsible local authority and each of its partner integrated care boards must, in exercising any functions, have regard to the following so far as relevant— (a) any assessment of relevant needs prepared under section 116 in relation to the responsible local authority’s area, (b) any integrated care strategy prepared under section 116ZB in relation to an area that coincides with or includes the whole or part of the responsible local authority’s area, and (c) any joint local health and wellbeing strategy prepared under section 116A by the responsible local authority and its partner integrated care boards. (2) NHS England must, in exercising any functions in arranging for the provision of health services in relation to the area of a responsible local authority, have regard to the following so far as relevant— (a) any assessment of relevant needs prepared under section 116 in relation to that area, and (b) any integrated care strategy prepared under section 116ZB in relation to an area that coincides with or includes the whole or part of that area, (c) any joint local health and wellbeing strategy prepared under section 116A by the responsible local authority and its partner integrated care boards.”

(7) In the following provisions after “joint” insert “local”— (a) section 17(6)(g) and (h) of the National Health Service (Wales) Act 2006; (b) sections 26(7) and 27(4) of the Children and Families Act 2014.

Explanatory notes

Each ICB and its partner local authorities will be required to establish an ICP, bringing together health, social care, public health (and potentially representatives from the wider public space where appropriate, such as social care providers or housing providers).

Annex C: representatives and organisations for ICP membership and engagement

We expect the ICP to have a broad membership and engagement with the organisations and communities it serves. However, this membership should be managed appropriately to ensure that the operations of the ICP remain efficient and effective. This illustrative list for ICP membership and engagement should not be viewed as a box-ticking exercise but as a genuine way of ensuring the partnerships include people able to represent and connect with communities and the voluntary sector. We welcome perspectives on whether there are any other voices who should form part of this list. For example:

• voices for children and young people
• patients, service users, and public voices
• voluntary, charity and social enterprise sector
• voices from the children’s board
• led by and for women’s organisations
• black and minoritised voices
• Healthwatch
• social care providers and workforce
• unpaid carers voices
• disability voices
• mental health providers and service users
• primary care (GPs, dental, eye care, pharmacy)
• NHS trusts and foundation trusts (acute, mental health, community, ambulance)
• community care
• public health voices (for example, directors of public health)
• local authority officers (for example, director of children’s services, director of adult services)
• acute care
• housing voices
• Criminal Justice System agencies, including probation services
• offenders health and care voices
• alcohol and addiction services
• homeless services
• social prescribing services
• learning disabilities and autism providers and service users
• businesses
• Local Enterprise Partnerships
• armed forces
• police and crime commissioners
• employment support services (for example, Jobcentre Plus)