The most significant development in health policy across England in 2022 has been the implementation of ICSs on a statutory basis. A key legislative move enacted through the Health and Care Act 2022, ICSs are now the new normal for the English health sphere as the Government tries to make the NHS more collaborative and granular in focus. The emphasis on patient input and the importance of local network is intended to establish a more joined-up, inclusive experience for patients.
The NHS has recently published a roadmap for integrating specialised services within ICSs which elaborates on the changes that will likely occur within ICSs in the coming years. Although, due to the flexible, individualised nature of each ICS, the development of each ICS will be different. ICSs will be mandated to develop multi-year plans which set out their plans for how to commission the 65 essential services from 2023-24 onwards – assessed by wider NHS regions this winter. A further assessment, again in November and December 2022, will assess the suitability of each ICS to provide the aforementioned core 65 services before a final decision is taken in February 2023. If approved, these specialised services will begin from April 2023.
If systems are not yet ready to take on full delegated responsibility from April 2023, further development support will be provided by putting in place formal joint commissioning arrangements between NHS England and NHS Improvement and ICBs by establishing statutory joint committees from April 2023. This will be part of a transitional period where extra support will be provided before full delegated responsibility is formalized from April 2024.
AI is becoming increasingly important throughout society and is affecting the way in which we live our lives more than ever. This is evidently true to the healthcare sector too. In May of this year, Health Education England published a report which examined healthcare worker’s confidence in AI. The report expressed concerns around the legal accountability in cases where AI failed to provide the best care possible for patients and how AI would impact their way of working, particularly the potential of higher patient recall leading to an unsustainable workload. It is these questions that need to continue to be posed and ultimately answered if our healthcare system is to seamlessly embrace AI technology now and in the future.
A draft code of governance for NHS Provider Trusts, issued by NHS England and NHS Improvement, has recently been published which sets out the expectations for boards to deliver effective leadership and decision-making to maximise positive patient experiences and outcomes. Importantly, the document reflects the changes and ambitions placed at the heart of the ICS project: collaboration and integration through more localised healthcare. Trusts are expected to meet all expectations established in the code, with any deviation from the code requiring thorough and reasoned explanations. In spite of their different constitutions, there are overarching principles of corporate governance that apply to both NHS trusts and NHS foundation trusts. These directives will hopefully provide the necessary leadership framework which will help our new ICS-shaped health landscape to flourish, particularly the influential Integrated Care Boards (ICBs).
The changes outlined in the ICS reports seem to point to a more successful future for the NHS, however, as has been noted in a recent report by the Royal College of Emergency Medicine (RCEM), infrastructure and action are just as critical if you are to collectively affect change. The report is damning in its findings, claiming an astonishing 25,000 hospital beds have been lost across the UK since 2010/11 despite population growth and increasing pressure on staff.
They claim this is a significant crisis for patient safety and the NHS workforce, the latter of which was extensively and heatedly discussed during the Health and Care Act debates without achieving a meaningful resolution. The RCEM recommend that beds must be increased by an additional capacity of 4,500 before winter, with a further 9,500 beds added over the next five years. It is now up to the new Prime Minister, whoever he or she is, to decide whether to enact the changes demanded.