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Local authorities call for ICBs to increase council representation and outline success measures 

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Councils are working starting to work closer with health partners within integrated care systems (ICSs) but require more representation at system level to drive improvements, this is according to the County Council Network (CCN).


The report, The Evolving Role of County Authorities in ICSs, analyses the progress of ICSs from the perspective of councils. The study, which was commissioned by the CCN and conducted by IMPOWER, 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. However, the CCN say there are significant challenges to overcome before councils can consider ICSs a true “partnership” endeavour.  

Local authorities feel there is a lack of processes in place to measure the impact of ICSs. In the report’s survey, less than one in five (18 per cent) of councils were confident that their ICS had a clear process for monitoring success against its primary objectives and national data on “integrated” issues was found to be very limited. 

The report has also found that across England, just nine of 777 Integrated Care Board (ICB) members are elected councillors. It 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.   

CCN’s report also suggests that council leaders feel that ICS are held back by a continued focus on mandated, top-down targets from the NHS and central government. It argues that this centralised control may hinder the success of local solutions rooted in long-term preventative measures developed within communities. 

The report recommends that the government and NHS review the level of centrally imposed targets on ICSs, particularly in shared policy areas with local government, which could help induce a culture shift that gives greater prominence to prevention. ICSs themselves should ensure that funding and decision-making are devolved to the most appropriate level in order to best facilitate local joint-working.  

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. 

CCN’s report comes ahead of Patricia Hewitt’s upcoming independent review of ICB oversight, which will be the first major stocktake on the role of councils in ICSs since their introduction in July of this year. 


Other key findings of the report: 

  • 80 per cent of councils say they have increased their time working with health partners since the inception of ICSs, but that this is in part due to too much of focus being given to immediate NHS pressures. 
  • 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. 
  • 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.  

Cllr Tim Oliver, Chairman of the County Councils Network, said: “Councils support the introduction of ICS 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 today’s 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.”  

Sean Hanson, Chief Executive of IMPOWER said: This report is the first to consider ICSs from the perspective of councils whose role is central to the integration agenda. It will be essential reading ahead of the Government’s upcoming review of Integrated Care Boards.  

“These systems are complex and their implementation varies widely across councils but our report is clear that the desire exists across local authorities and the NHS to reduce health inequalities, boost preventative services and improve outcomes for citizens. However, there is concern that a lack of local autonomy and squeezed budgets will make it difficult to convert that desire into action.”