It’s the big shake-up in NHS health and social care that few who work outside of NHS and health circles will know anything about, but it will likely affect us all in one way or another.

That’s the formal introduction of new Integrated Care Systems, which will be up and running next month, along with boards that will manage them, known as Integrated Care Boards.

If none of this makes sense to you, read on for an explanation.

What’s happening?

The Government’s Health and Care Act 2020 gives legal status to Integrated Care Systems and Integrated Care Boards.

The Parliamentary process was completed and Royal Assent received at the end of April, meaning the proposed changes are now enshrined in law.

The outcome is that the NHS across England is being divided into 42 new NHS bodies with Integrated Care Systems (ICS) – essentially local partnerships bringing the NHS together with other key partners, such as local authorities – each being overseen by an Integrated Care Board (ICB).

The changes also mean that Clinical Commissioning Groups (CCG) such as the Tees Valley CCG will be no more and their functions replaced.

Why does this matter?

Like the CCGs do now the organisations will oversee local primary care used by us all – essentially the care provided in the community for people making an initial approach to a GP or clinic for advice or treatment.

They will also determine how the NHS budget for their area is spent, ensuring it is value for money and establish shared strategic priorities aimed at boosting the health of a local population, while tackling current challenges such as obesity.

The Government generally wants to see a more ‘joined up’ approach being taken to healthcare.

The organisations are also being given new powers, for instance taking on delegated responsibility for pharmaceutical, general ophthalmic and dental services by next April. 

In our region a North East and North Cumbria ICS and board has been formed, which health chiefs hope will ultimately provide the best care for communities.

It will be one of the biggest in the country in terms of the area it covers.

So CCGs are on the way out – what do they do?

They plan, commission and pay for NHS healthcare services for the population they serve. As an example the South Tees NHS Hospitals Foundation Trust received more than £493m in 2021/22 from CCGs for its services. The Tees Valley CCG also represents more than 80 GP practices and is responsible for engaging with the public and ultimately making decisions on surgery provision. It has also been heavily involved in the administration of the coronavirus vaccination roll-out.

How is the Tees Valley CCG currently managed?

It has a governing body consisting of local doctors, nurses and experienced managers which meets regularly in public. It’s not yet clear how these public meetings will be replicated,  or how this will break down in terms of the several sub-regions within the North East and North Cumbria.

The south area currently covered by the Tees Valley CCG has a population of 847,000 people, 17 primary care trusts and three hospital trusts and will now only be one part of the new ICS.

Weren’t there previously several different CCGs operating in the area?

Yes there was a NHS Darlington CCG, NHS Hartlepool and Stockton-on-Tees CCG and NHS South Tees CCG, which merged to form a new NHS Tees Valley CCG in April 2020.

Its 93 staff will transfer to the ICS on July 1.

What can we expect from the North-East and North Cumbria ICS?

The organisation already has a glossy new website up and running and a designated chairman, Professor Liam Donaldson, the UK’s former chief medical advisor between 1998 and 2010, who was born in Middlesbrough.

It says the quality of our health and care services delivered across the region is consistently rated amongst the best in the country and there is a “strong track record” of being at the forefront of innovation and transforming care.

Despite this, overall public health is still amongst the worst in the country and although there have been many improvements in recent years, for example the number of people dying from cancer or heart disease has decreased, fewer people are smoking and many are living longer; healthy life expectancy remains amongst the poorest in England.

Prof Donaldson said: “We want to change this by working together as an Integrated Care System whereby every partner organisation is fully committed to and focused on creating a common purpose and joint determination to drive improvements in health, wealth and wellbeing.”

The new body says high levels of unemployment, low levels of decent housing, and significant areas of deprivation contribute to stark health inequalities, early death rates and the highest sickness levels in England, driving much of the pressure that health and social care struggle to manage.

To help address this, North Tees and Hartlepool NHS Foundation Trust chief executive Julie Gillon has been appointed as an Integrated Care System senior responsible officer for health inequalities.

And a number of priorities have already been agreed in a bid to improve the health of the area’s three million population, including
Prevention, early detection and effective management of the biggest causes of premature mortality: cancer, cardiovascular and respiratory disease
Better lung health, with an ambition to achieve a smoke free generation and a fully smokefree NHS.

More effective management of frailty to ensure no one is admitted to hospital that could have been cared for more effectively in their own home with the right personalised care, and doing more to tackle social isolation 

Improving the emotional well-being and mental health of infants, children and young people, recognising the lifelong impact of adverse childhood experiences

Improving outcomes for people who experience periods of poor mental health and specifically those with severe and enduring mental illness.

The ICS says most of its work will continue to be focused in places and neighbourhoods, but the new structure is a way for us to “work together on regional issues that need to be tackled at scale”.

It also seems to have bigger ambitions, not just regards health and social care, stating:

“Through closer working with our local authorities and all our partners, our ambition is to also bring together not just health and social care but also education, planning, housing, environmental health and leisure services for the benefit of local communities.”

Chief executive designate Sam Allen said the changes are a “once in a generation opportunity for us all to come together” – the NHS, local government, social care providers, charities, and voluntary, community and social enterprise partners and many more to tackle the many inequalities being faced in the region.

What has the Government said?

In a statement the Department for Health and Social Care said: “As part of the measures to deliver more joined-up care, every part of England will be covered by Integrated Care Systems bringing together NHS, local government, and wider system partners to put collaboration and partnership at the heart of healthcare planning. 

“On 1 July, Integrated Care Systems will take responsibility for the commissioning of most NHS services. 

“This will be done at the same time as abolishing Clinical Commissioning Groups.”

It said that commissioners of healthcare services would be provided with more flexibility courtesy of the new regime on how to select providers and when competitive tendering adds value.

“This will enable commissioners to deliver well-coordinated and more joined up healthcare,” the statement added.

All seems tickety-boo then, has there been any concern about the changes?

There have been suggestions from campaign groups that there could be more involvement from private companies in respect of ICBs, although this has been denied. 

Public ownership campaign group We Own It has called on Prof Donaldson to commit to banning private companies and the people who work for them so they have no role in decision making and potentially stand to benefit financially from healthcare decisions.
The level of accountability in terms of the extent to which local elected members, for example councillors, will be able to get involved and whether there will be representation from individuals whose job it is to champion patient interests is another slight grey area at the moment until we fully know the make-up of the new boards and how things will work moving forward.

Eight ‘member partners’ are due to be recruited onto the ICB in the North East and North Cumbria, including two members from NHS and foundation trusts within the area, two members from general practice providers and four members from the 13 local authorities within the ICB’s area responsible for providing social care services.

Others critics argue that such a big shake-up with all the time and costs that will flow from it is not required at a time when the NHS is already under severe pressure and has other priorities.

Where can I find out more?

The North East and North Cumbria ICS website can be found here and there’s a helpful video here that’s been produced by the independent charitable organisation the King’s Fund.