We know some of the changes to health and care can be complicated. Here are some frequently asked questions that might help with explaining the proposed changes.

General questions

Q. What is an integrated care system (ICS)?

ICSs are a way of working that brings together all the health and care organisations in a particular local area, to work together more closely. There are 42 ICSs across England and they will be more formally established in July 2022. Many health and care organisations have already been working in this integrated way successfully, particularly through the pandemic, and this is the next step in recognising this success. Each ICS will be responsible for looking after and delivering all the health and care services in the area it covers. Each one will be made up of an integrated care board and an integrated care partnership, working together.

Q. What is an integrated care board (ICB)?

The Integrated Care Board – to be known as

NHS Sussex

– will become a new organisation that will agree the strategic priorities and resource allocation for all NHS organisations in Sussex. This will involve leading the improvement and integration of high-quality health and care services for all communities. NHS Sussex will take on the commissioning functions previously carried out by Clinical Commissioning Groups (CCGs).

Q. What is an integrated care partnership (ICP)?

The Integrated Care Partnership – to be known as the

Sussex Health and Care Assembly

– will be the statutory joint committee between the NHS and local government that comes together to formally agree the strategic direction for our system. The core purpose will be to facilitate joint action across organisations to improve the outcomes, equality of access and experience of health and care services for all people and communities across Sussex.

The Assembly will have a specific responsibility to develop an ‘integrated care strategy’ for its whole population using the best available evidence and data, covering health and social care, and addressing health inequalities and the wider determinants which drive these inequalities.

Q. What are the four key purposes of an ICS?

The four key purposes of an ICS are outlined in the guidance document from NHS England and NHS Improvement. These are:

• improving population health and healthcare

• tackling unequal outcomes and access

• enhancing productivity and value for money

• helping the NHS to support broader social and economic development

Q. Why make these huge changes now, with the pressure already on the NHS?

ICSs becoming statutory in July 2022 is part of a development journey that has been taking place for a number of years. Many areas of the country are already working in integrated ways, and this has proven particularly successful during the pandemic when services had to work differently. The health and care system is currently under significant pressure dealing with the current demand on services, the ongoing management of COVID-19, and the recovery from the consequences of the pandemic. July represents the starting point for

further system development which aims to help manage the current situation, address many of the challenges faced today and improve services in the future.

Development of ICSs and the health and social care bill

Q. What is the health and social care bill?

The health and social care bill outlines all the proposed changes to the way health services and social care services will run. The bill will bring ICSs into law from July 2022 if it goes through Parliament successfully, which it is expected to. The bill and the changes it brings are supported widely across the health service.

Q. What led to the need for integrated care systems to be created?

It is recognised nationally that the way people have received care in the past has been too fragmented and the way our health and care system has traditionally worked has meant our organisations have worked in competition, rather than in partnership, with one another. This has at times resulted in unnecessary delays in care and treatment, has negatively impacted on patient experience, caused inefficiencies in terms of time, energy and resource, has exacerbated inequalities across communities, created unnecessary variations in care, and created counterproductive actions that positively effects on parts of the system at the expense of another

Many of the changes in the health and care bill came from NHS England and NHS Improvement, based on wide consultation with a range of other health and care partners. In most part, the proposals set out in the bill represent legislation catching up with what has already been happening for years within health and care across the NHS, local authorities and the community and voluntary sector around the country. Working in an integrated way will improve patient care and help to remove barriers to care.

Q. Is there support for ICSs among health and care leaders?

Yes, there is broad support across health and care for the vision of integrated care systems, as they are partnerships that aim to work collectively towards more effective population health management; a robust public health framework based around prevention; and bringing care closer to people’s homes. This is bottom-up reform led by the NHS that will remove barriers to care, enable integration and lead to better services for patients.

Q. Are all ICSs developing at the same pace?

No, some areas are more developed than others and this is how it should be. The health and social care bill will enable them to develop in their own way, without imposing the same way of working across the country. Each ICS needs to be developed in a way that best meets the needs of its local population. As a result, ICSs are intentionally varied. The governance and way of working for the Sussex ICS is currently being agreed across partners.

Q. How will ICSs take forward lessons learned from the pandemic?

The pandemic has highlighted the need for working in collaboration and integrated working across health and care, and there are many successful examples of this across the country. There is now the opportunity to build on this with the next step in system development and embed the collaborative working across partners.

Q. How are local authorities involved in the new ICB and ICP?

Upper tier and unitary Local Authorities are required to be members of ICSs as key partners. In the Sussex ICS, East Sussex County Council, West Sussex County Council and Brighton and Hove City Council are each represented on both the NHS Sussex ICB and the Sussex Health and Care Assembly. To provide professional knowledge and perspective it is suggested that Local Authority representation on the NHS Sussex ICB from the three Councils is made up of one Director of Adult Social Services, one Director of Children’s

Services and one Director of Public Health. The representatives would each be on the ICB as partner members and would not act in a delegated capacity either for their organisations/sector or their specialist area. It is suggested that the Chairs of each of the three Health and Wellbeing Boards will be the Local Authority representatives on the Sussex Health and Care Assembly, supported by Officers where this is helpful.

Q. What roles have already been appointed to in the ICB?

A national process was undertaken by NHS England to simultaneously appoint Chair Designates and Chief Executive Designates to all 42 future NHS ICBs late last year. Stephen Lightfoot was appointed as the new Chair Designate for the future NHS Sussex ICB, and Adam Doyle the new Chief Executive Officer Designate. Five voting Executive Directors have also been appointed to the ICB – Chief Medical Officer, Chief Nurse, Chief Finance Officer, and Chief Primary Care Officer – as well as five Non-Executive Directors.

Q. What are place-based partnerships?

The new integration White Paper supports the Health and Care Bill and describes the arrangements expected at ‘Place’. Places represent the sub-systems within ICSs that involve health and care partners working together to focus on the health and care needs of local populations, integrated care at a local level and reducing health inequalities. There three Places in Sussex, based on the upper tier local authorities and Health and Wellbeing Board boundaries – West Sussex, Brighton and Hove and East Sussex. Each has a health and care partnership that enables join working across organisations working at Place.

Benefits for patient care

Q. How will ICSs benefit populations?

People often have multiple health needs and end up needing support from a variety of services. Working in a collaborative and co-ordinated way will help to make the service more person-centred. Currently, the NHS and care services are organised as lots of separate organisations working autonomously. ICSs provide a partnership structure, allowing all these organisations to work together to help to improve the health and wellbeing of the public in the area they serve. Additionally, ICSs will put greater focus on improving population health and outcomes, as well as the delivery of services. Organisations will arrange themselves around, and focus more on, the needs of the communities with the aim of reducing health inequalities and improving preventative action, access to services and treatment.

Q. How will ICSs help to reduce the pressure on the NHS?

There needs to be a focus on public health and prevention that goes beyond hospitals and traditional care settings. By focusing on joining up local services, systems can improve the health of their local communities and tackle long-standing inequalities that result in poorer and deprived communities experiencing worse outcomes and often dying younger. Moving to proactive care models will ultimately protect hospitals from extra demand.

Q. What are the challenges facing ICSs when it comes to improving care?

We now have more people needing care, often with more severe needs, and this is putting additional pressure and demand on services all the time. At the same time, we have a large backlog of people waiting for operations and procedures due to the pandemic. Addressing these issues are not a quick fix and there is limited resource available, in terms of workforce and money. This will require health and care organisations working together on long term actions.

ICS accountability

Q. How will the ICSs be accountable to the public?

The bill includes a legal duty for ICBs to involve and consult with the public on planning and delivery. There is a clear role for health and wellbeing boards, while the ICB and ICP strategies will be published to ensure that there is transparency and accountability. ICSs will be both outwardly accountable to local health and wellbeing boards, health overview and scrutiny committees and members of the integrated care partnerships (all including elected local councillors) and upwardly accountable to the Secretary of State for Health and Social Care, and in turn to parliament and the electorate.

Q. Is there a risk that the ICS will be too NHS focused?

The ICS should be a partnership of equals between the NHS and local government. Integrated care partnerships will bring together a broad partnership, including representatives from the voluntary and community sectors and further education.