Health changes leave county with England’s ‘most complex NHS arrangements’

Essex County Council will have to deal with the most complex set of NHS arrangements in the country – meaning its resources will be spread more thinly “than it would like”.

It comes following a reorganisation of the way health care is provided with the introduction of integrated care systems (ICSs).

These are geographically-based partnerships that bring together providers- such as NHS Trusts – and commissioners such as the clinical commissioning groups – of NHS services with local authorities and other local partners to plan, co-ordinate and commission health and care services.

The Government says they are part of a fundamental shift in the way the health and care system is organised – away from competition and organisational autonomy and towards collaboration, with health and care organisations working together to integrate services and improve population health.

ICSs have been developing for several years – the Health and Care Act puts them on a statutory footing from July 2022 – and each authority has to formally adopt to the new system. Each is made of a integrated care board (ICB) and an integrated care partnership (ICP).

An ICB will take on the NHS planning functions previously held by clinical commissioning groups (CCGs) and are likely to absorb some planning roles from NHS England.

And an integrated care partnership which will operate as a statutory committee, bringing together the NHS and local authorities as equal partners to focus more widely on health, public health and social care.

But in Essex there has been some concern at the complexity facing Essex County Council that is having to deal with three integrated care partnerships (ICPs) – Mid and South Essex, Hertfordshire and West Essex and Suffolk and North East Essex and three integrated care boards (ICBs) for each of the areas.

A statement to cabinet said: “This is the most complex set of arrangements in the country and means that our resources will be spread more thinly than we would like.”

It adds that the council expressed concern about this in its response to the consultation on boundaries in early 2021 arguing the boundaries make it difficult to ensure consistency of outcomes for Essex residents and creates some fragmented governance arrangements.

A statement to cabinet that is set to formally adopt the new arrangements on June 21 said: “The council strongly argued that it should not be in more than one integrated care system and argued that being in one system would create a simpler and more logical set of arrangements that would better enable local government and NHS to be aligned around the same geography and populations.

“The Government considered the possibility of alignment but decided that placing Essex in a single ICS would involve disruptive reforms to the NHS.”

Mid and South Essex is covering Basildon, Braintree, Brentwood, Castle Point, Chelmsford, Maldon and Rochford plus the unitary authorities of Southend and Thurrock.

Hertfordshire and West Essex is covering Epping Forest, Harlow and Uttlesford plus the county of Hertfordshire (excluding the town of Royston).

Suffolk and North East Essex is covering Colchester and Tendring and the county of Suffolk except the former district of Waveney.

The Health and Care Act 2022 has important implications for Essex County Council and Essex NHS organisations. It will see the abolition of GP-led clinical commissioning groups.

ICPs in their place will operate as a statutory committee, bringing together the NHS and local authorities as equal partners to focus more widely on health, public health and social care.

“ICPs will include representatives from the ICB, the local authorities within their area and other partners such as NHS providers, public health, social care, housing services, and voluntary, community and social enterprise (VCSE) organisations.

A statement to cabinet added: “The fact that Essex County Council is in three ICS areas will make it particularly challenging to resource and have the maximum influence given that we will have to service three ICBs and three ICPs and yet we will need to ensure that the voice of Essex residents is given due regard in these important new systems.”

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Piers Meyler

Local Democracy Reporter