Last Updated on November 22, 2022

The first major review on the role of councils in Integrated Care Systems (ICS), since their introduction, calls for ICS leaders to turn intentions into real action or risk disengagement with councils.

IMPOWER’s new report, The Evolving Role of County Authorities in ICSs analyses the new systems which replaced Clinical Commissioning Groups this year from the perspective of councils. The study, commissioned by the County Councils Network (CCN), is based on a detailed survey and interviews with local authorities in county areas and senior health officials.

County leaders say councils and health partners are forging closer relationships in many ICSs across England, and evidence in the study shows that council leaders are investing significant amounts of time with health colleagues within these arrangements. While these signs are positive, there are significant challenges to overcome before councils can consider ICSs a truly ‘partnership’ endeavour.

The report, released at CCN’s Annual Conference, finds:

• Local Government is spending more time with NHS colleagues, with 80% of council respondents saying they have increased their time working with health partners since the inception of ICSs. But, in part because there has been too much of a focus on immediate NHS pressures, only just over half (56%) feel this is even somewhat justified.
• Local authorities are ‘very cautious’ about pooling further resources with the NHS at a time when finances are stretched, particularly as the NHS is felt to have less focus on living within budgets than councils. Nationally, county authorities have pooled £13.43 per-head from their budgets into the Better Care Fund (BCF) this year; down from £15.56 per capita in 2017-18.
• Across England, just nine of 91 Integrated Care Board (ICB) members – the decision-making body of the ICS – are councillors. The report highlights that both councils and the NHS recognise that local politicians will need to be key allies if ICSs are to deliver transformative change, but that their role in systems is still unclear.

Councils recognise the need for decision-makers in ICBs to tackle immediate issues in the NHS and acknowledge they are also facing real pressures on their own services. However, there is concern that in the medium term it will be difficult to shift focus onto overarching, long-term system issues such as investing in preventative measures and out of hospital care as envisioned in the NHS Long Term Plan.

It also calls on council and local NHS leaders to agree on a small number of specific and achievable inclusive ambitions this winter to build partner confidence in ICSs’ ability to deliver real change.

Cllr Tim Oliver, Chairman of the County Councils Network, said, ‘Councils support the introduction of ICSs and their aim to closer integrate health and care services and ultimately drive down costs for both the NHS and local government through preventative measures. Since their inception, evidence shows that councils have been enthusiastic about these arrangements and are spending more time with health colleagues.

‘But the report acts as a useful barometer to find out what is happening on the ground in ICSs across England. Partly as a result of the funding challenges facing the NHS, and top-down central targets, there is a feeling from councils that there is too much focus on immediate and acute NHS pressures, such as hospital discharge and ambulance waiting times, rather than the preventative agenda.

Adding, ‘There is a risk that councils’ cautious optimism turns into disengagement, with some colleagues feeling locked out of the decision-making processes within ICS. If the focus on immediate NHS pressures continues, then there is a high chance councils will view ICSs as simply another NHS reorganisation to work around.’

‘It is imperative we learn the lessons of these first few months of working in ICSs’ and look to forge a culture where local decision making and preventative health and care is given equal footing to acute pressures. Today’s report sets out some key recommendations to move towards this.’

Visit the County Councils website to download the report in full.

In other news, the Department of Health and Social Care (DHSC) has published details of how the £500m Discharge Fund will be distributed to help free up hospital pressures and reduce strain on the NHS.