Achilles’ heel: Schedule 2 Integrated Care Boards

Yesterday (22 November 2021) saw the Health and Care Bill move to the Report stage in the House of Commons, with the final day of the stage coming to a close today.

One of the tabled amendments made by the Health and Social Care Secretary relates to Integrated Care Board members. Amendment 25 would seek to prevent the appointment of a member of an ICB “if they could reasonably be regarded as undermining the independence of the NHS because of their involvement in the private healthcare sector or otherwise”.

The amendment provides that Integrated Care Systems’ constitutions “must prohibit a person from appointing someone as a member (“the candidate”) if they consider that the appointment could reasonably be regarded as undermining the independence of the health service because of the candidate’s involvement with the private healthcare sector or otherwise.”

But how this will be applied in practice remains unclear.

ICB board members will be involved in the commissioning of NHS services and allocating NHS funding to provider collaboratives and partnerships working in local ICSs. It is worth noting that the Bill in its current form revokes existing procurement and competition rules and provides for the introduction of the new provider selection regime allowing for a more collaborative approach to the planning and delivery of healthcare services.

There have been ongoing concerns about independent sector involvement in the NHS but they have always played a role in the provision of healthcare services. Interestingly, NHS Providers say in their Report stage briefing that there was “no significant increase in the share of the NHS’s total revenue budget going to private providers, which has stayed relatively stable at around 7%.”

Independent sector providers remain an important partner in the local health and care system and as NHS providers explain contributed to the pandemic response and recovery by providing additional capacity. They are also a key delivery provider in a number of mental health provider collaboratives.

NHS Providers have raised a number of concerns about the amendment, including seeking assurances from the House of Commons that:

• This will not prohibit GP practices from sitting on ICB boards.
• There is sufficient flexibility that the amendment allows for community interest companies and the voluntary, community and social enterprise sector to sit on the ICB board.

If this amendment is to remain, ICB chairs who effectively will have a veto on all appointments to the board will need clear guidance to advise on specific arrangements involving ICB members.