Is there a new Health and Care Bill?
Yes. The Bill contains a series of measures which would formally establish Integrated Care Systems (‘ICS’) like West Yorkshire Health and Care Partnership and give their governing bodies – including an NHS Integrated Care Board – more responsibilities, empowering them to better join up health and care, improve people’s health and reduce health inequalities.
While it is not possible to pre-empt the decisions of Parliament, the Bill received a positive vote at Second Reading. This means there is a degree of confidence that the measures relating to ICSs will become law. In turn, that means the NHS locally, regionally, and nationally – alongside all partners - has a responsibility to prepare for when those measures are expected to come into effect, which is currently July 2022. More information is below.
What is the integrated care board (ICB)?
The integrated care board is statutory organisation which will be responsible for leading NHS joined up care at a West Yorkshire level. It will develop a plan to meet the health needs of people and the provision of health services. It is accountable for NHS spend and performance within the West Yorkshire system.
It will bring together health, care, voluntary community social enterprise sector (VCSE) and Healthwatch partners at West Yorkshire level. It is the formal decision-making body of the ICB and will make decisions about ICB functions and resources.
It will work with local place-based partnerships. This is the ‘umbrella’ term for the local partnerships which bring together health, care, VCSE and Healthwatch partners in Bradford District and Craven; Calderdale, Kirklees, Leeds, and Wakefield, to improve health and wellbeing for people.
Who is the chair of the board?
The Chair of the Board is Cathy Elliott. Cathy will have a hugely important role. She will drive improved services for people and better population health and help to ensure the delivery of long-term local strategies and priorities into next year and beyond including the vaccine roll-out, elective recovery and addressing health inequalities.
How does the board work together?
A constitution will set how the board works together and who the members are. A constitution is a set of principles and rules that help assure its members and external organisations on how it will be governed.
What will be in the West Yorkshire Integrated Care Board’s Constitution?
Each ICB must set out its governance and leadership arrangements in a constitution. It must base this on a model developed by NHS England. The constitution of the ICB will set out the role of the board, the process of appointing the partner members and the criteria that must be met to be appointed as a member.
Each ICB will need to align its constitution and governance (how decisions are made) with the West Yorkshire Integrated Care Partnership (ICP) which is another part of the Integrated Care System (ICS). The Integrated Care Partnership (ICP) will be the forum which brings together a wide range of health and care partners across our region to agree the high-level strategy for our partnership. The ICP will be a joint committee of the West Yorkshire local authorities and the ICB, so cannot technically be formed until the ICB is established.
However, our existing Partnership Board is essentially already operating as an ICP and has been a key forum for overseeing effective stakeholder involvement in the development of our constitution.
While getting our structures and governance right is crucial, integrated care is all about practical, real improvements to people’s health, wellbeing, and care.
Who will approve the ICB Constitution?
The regional team of NHS England and NHS Improvement will formally approve the constitution at which point it will stop being called “draft”. Nothing can be approved until we have engaged with partners and other stakeholders on the content of the constitution, including Healthwatch. Healthwatch is an independent statutory body, who have the power to make sure NHS leaders and other decision makers listen to people’s feedback and improve standards of care.
When will the West Yorkshire ICB Constitution be approved?
At the moment, we understand that this will be approved in July 2022.
Why are we engaging with people and organisations about the draft constitution?
Although it is a legal duty for us to engage with partners and stakeholders about the draft constitution, we also believe we will have a better set of rules to govern ourselves if interested people are involved in developing them.
Whose is responsible for involving stakeholders in the development of the draft constitution?
It is the duty of the West Yorkshire Clinical Commissioning Groups (CCGs) to involve stakeholders in the development of a draft constitution and then to engage with anyone who may have and interest or be affected by the contents. So that this is done in a systematic, fair way across West Yorkshire this responsibility has been given to West Yorkshire Health and Care Partnership. The communication plan has been produced with colleagues in each area and they will engage stakeholders in their area. This is because they have good relationships with those people and organisations.
Is this engagement an opportunity to give your opinion on the Health and Care Bill?
No. The Bill is in Parliament and no longer open to public comment. This engagement exercise is specifically about the draft constitution for West Yorkshire ICB.
How are you involving stakeholders in the process?
Colleagues from Clinical Commissioning Groups have helped to develop the draft Constitution. Both West Yorkshire Health and Care Partnership and the CCGs will share this with all their stakeholders for comments. In many cases this will be in face to face or virtual meetings but for some it will be in briefings or bulletins. Every document necessary will be available on our public website where a special area has been dedicated for this purpose.
When will engagement take place?
We are asking for views on our draft constitution, developed by colleagues in Bradford District and Craven, Calderdale, Kirklees, Leeds, and Wakefield, from the beginning of November 2021 through to January 2022.
As we progress there will be opportunities for you to discuss and share your thoughts and ideas with us and help us to create a meaningful constitution.
Can we discuss this at our patient group?
Yes, if you feel your patient group will find the contents of the draft constitution of interest or if you feel your group might be affected by any change you should get involved.
Will organisations, at local level, be able to change anything about the engagement?
Colleagues at local level have been involved in discussions with the Partnership in developing the communications and involvement plan. There have been regular meetings with colleagues and where they have been kept up to date with progress. They have been able to influence the plan and certainly will be essential to local involvement and deciding who to involve locally.
How involved will the local teams be in contributing to the development of the engagement work?
Local engagement experts and teams will be delivering the communication and involvement plan in their areas (Bradford District and Craven, Calderdale, Kirklees, Leeds, and Wakefield). They will need to develop a stakeholder list, engagement methods that work for them locally and will be using resources developed by West Yorkshire Health and Care Partnership. Local expertise and knowledge will be essential to the successful engagement around the draft constitution.
Is there is any public or patient assurance at a West Yorkshire level? I know people are working on this and figuring it out, but given that this piece of work is happening soon, what are the plans for assurance on it?
We have taken advice from the Consultation Institute and the plan will go to our CCG Public and Patient Assurance Group (the Non-executive members of the CCG Governing Bodies responsible for public and patient involvement) in November. It will also be shared with the existing Partnership Board which includes co-opted members of the public.
The meeting will be held in public in case people have comments. We will take legal advice on the draft constitution prior to making it public.
You keep mentioning stakeholder involvement. Are citizens able to be involved in commenting about the draft constitution?
We will be involving all those individuals and groups who are already involved with partner organisations because we think they will be interested. We are not sure how interested the public will be but welcome views on the contents of the draft constitution from anybody and any organisation.
What is the Health and Care Bill?
On 6 July 2021 the Health and Care Bill was published, setting out key legislative proposals to reform the delivery and organisation of health services in England. This should promote more joined-up services and put more of a focus on improving health (preventing ill health) rather than simply providing health care services.
The purpose of the Bill is to establish a legal framework that supports joined up working rather than competition and many of its proposals have been informed by the NHS’s recommendations. The Bill also contains new powers for the Secretary of State over the health and care system, and targeted changes to public health, social care, and quality and safety matters.
Will the Bill make any difference to patients?
Yes, the Bill provides opportunities to improve people’s outcomes and experiences of care, particularly for those in contact with different services, through better integrating services both within the NHS and across the health and social care system.
When will the Health and Care Bill be agreed?
The Bill will be debated in parliament throughout autumn and winter 2021 and is expected to be passed in time for changes to come into effect in July 2022.
Will the Bill lead to greater involvement of the private sector in delivering and planning clinical services?
No. An integrated care system is composed of providers and commissioners of NHS and social care services across West Yorkshire with local authorities and other local partners to collectively plan health and care services to meet the needs of our population. There is no private interest representation on the West Yorkshire Integrated Care Board. However, working with non-NHS providers to deliver clinical services, offer choice and relieve pressure on the NHS is not a new development. This already happens in the current structure. The Bill proposes to reduce the role of competition and increase the flexibility around procurement rules. This does not necessarily have implications for the involvement of the private sector in delivering clinical care in the NHS.
Integrated Care Systems (the ICB and ICP)
What will the new system look like?
Integrated care systems (ICSs) are partnerships that bring providers and commissioners (those who buy services) of NHS services across a geographical area together with local authorities and other local partners to collectively plan health and care services to meet the needs of their local population. The Health and Care Bill introduces two-part statutory ICSs, made up of an integrated care board (ICB), responsible for NHS strategic planning and allocation decisions, and an integrated care partnership (ICP), responsible for bringing together a wider set of system partners to develop a plan to address the broader health, public health, and social care needs of the local population. West Yorkshire Health and Care Partnership is currently known as an integrated system, but it does not have legal (statutory) duties.
What does this mean for people who use services?
The COVID-19 pandemic has given the NHS and its partners their biggest challenge of the past 70 years. It has shown that people need support joined up across local councils, the NHS, and voluntary organisations. No hospital, GP surgery or care home could rise to the challenge alone. The pandemic has shown that a commitment to collaboration between these organisations, based on the interests of the people they serve, is the best way to improve results. Partners have shared resources and made decisions quickly to provide the care and support that local people need.
What is important now is that, as we recover from the pandemic, we capture and build on this spirit of joined up working between partners. We need services that understand our increasingly complex health and care needs and treat people as individuals.
How will it improve our lives?
They are working together to improve people’s lives so that they don’t just live longer but have healthier lives. By working together and collaborating more effectively we will be able to improve our healthcare by being more joined up in how we support people and communities. This will improve the health and wellbeing of the area, allow care to be tailored for individual needs and help prevent people needing health and care services unless needed.
What does this mean for staff and local people? How will the changes affect them?
We will draw on local knowledge about the priorities and challenges in different parts of our area. Frontline staff are crucial to understanding these. Many of our senior leaders come from a clinical background and leadership teams often include clinical representatives. Working in this way will allow areas to think about long-term solutions to local workforce goals and challenges, as well as supporting staff to develop their skills and provide the best care possible. It also means we can share and scale up good practice across West Yorkshire and face the difficult challenges and issues to overcome them. This in turn benefits local people.
Are there plans to have lay members on decision making bodies?
We are committed to involving local people in the work we do and the decision-making process both at West Yorkshire and locally across Bradford District and Craven, Calderdale, Kirklees, Leeds, and Wakefield. We will ensure we meet the statutory duty for involvement. However, our ambition is to go much beyond solely meeting the statutory duty. This means we will be looking at active involvement in our decision-making committees as well as our system level programmes. With the future arrangements still being worked through, including a constitution for integrated care boards we are unable to confirm the exact arrangements but can assure people that involving people and communities is one of our guiding principles.
Update: Tuesday 7 December 2021
Integrated Care Boards will be able to delegate powers to providers or provider collaboratives but are not mentioned in the Health and Care Bill. Are they mentioned in the draft constitution?
No, we have no plans to include providers or provider collaboratives in the West Yorkshire Constitution.
Is our draft constitution like those in other areas?
We feel that West Yorkshire is a large and advanced Partnership. We have five local areas that are well advanced in their planning and are fortunate geographically that these areas all only have one local authority each. We are therefore in the fortunate place of being able to delegate decisions and some budgeting to these areas and this is reflected in the draft constitution.
Some of the language used and naming or organisations nationally is confusing and contradictory.
We agree. We are committed to trying to use language familiar to colleagues and citizens. For example, local organisations will be named by local organisations.
How do you intend to put the voices of people and communities at the centre of decision making and governance at every level of the Integrated Care Board? Will there be citizen representatives on the Board.
The Board will have a representative from Healthwatch, which work to understand the needs, experiences and concerns of people who use health and social care. There will also be an independent chair and three independent non-executive directors. Meetings will be held in public, and the public will be encouraged to put forward any questions they have on the agenda items. All questions and answers will be publicly available. Public involvement is not limited to Board membership. We have various ways we involve the public in our existing work, including four independent co-opted public members on the current Partnership Board, lay members on programme boards, a citizen panel for planned care, cancer community panel and youth collective voice group, to name a few. We are absolutely committed to working with communities to ensure openness and transparency and this will continue.
There does not appear to be a dedicated place for patients/public/citizens on the Integrated Care Board (ICB)
The Health and Care Bill requires that ICB boards have a minimum of two non-executive directors (NEDs) - one with specific knowledge, skills and experience in relation to the Audit Committee and one in relation to the Remuneration Committee. Although we will need to ensure that these two NEDs meet these specific requirements, our intention is that these roles will be defined much more broadly than this, for example in relation to quality and safety, equality, diversity, inclusion, and experiences of people who access care. We also propose an additional NED who will have responsibility for issues around future generations, citizen voice and sustainability. In addition to the NEDs on the ICB Board, the perspective of citizens will also be brought by the proposed Healthwatch member.
The ICB Board will be just one part of a complex and inclusive decision-making framework, which seeks to embed public and patient involvement across our system. We involve the public and patients in our existing work in various ways, including four independent co-opted public members on the current Partnership Board, lay members on programme boards, a citizen panel for planned care, cancer community panel and youth collective voice group. We are absolutely committed to working with citizens to ensure openness and transparency and this will continue. Section 9 of the constitution sets out our proposed approach.
Will there be a GP and social care member on the Integrated Care Board?
Yes, these will be the Partner member and local authority member of the Board.
Do you intend to have Integrated Care Board meeting in public?
Meetings of the Partnership Board are held in public now and this will continue with the ICB.
The West Yorkshire Integrated Care Board will cover a large area, how will the areas within it (Bradford and Craven district, Calderdale, Kirklees, Leeds, and Wakefield) be represented?
There is place on the board for each area to have representative.
The current Partnership has done outstanding work on race equality. Will the ICB be looking at outcomes for all marginalised communities for example LGBTQ+ and people with disabilities?
Although our work on race equality has been high profile the Partnership is commitment to reducing the inequalities experienced by people from marginalised communities. This will continue to be a priority for the Integrated Care Board.