NHS Integrated Care System Boundaries

David Amess Excerpts

Tuesday 29th June 2021 Commons Chamber

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I am sorry that this debate is unlikely to be the penalty shoot-out that some people may have been looking for.

We know that the Government are about to publish a new Bill on the NHS, but it is not widely known or understood that the NHS in England is being prepared for a major reorganisation. The clinical commissioning groups established by the Lansley reforms have gradually been subsumed into groups called integrated care systems. These ICSs are not legal entities, but single executive teams that have effectively merged the CCGs. Their boundaries are established according to the local health economies. For example, the North East Essex CCG has been merged with two Suffolk CCGs to form the Suffolk and North East Essex ICS, which commissions all NHS services across the whole area. This enabled Ipswich Hospital NHS Trust and Colchester Hospital University NHS Foundation Trust to be merged. I have to say that this is highly effective. In my nearly 30 years as a Member of Parliament, I can honestly say that the NHS in our area has never been better led.

[Sir David Amess (Southend West) (Con)]

I know that my hon. Friend will agree that we have had a fabulous football result this evening.

Going back to the days when my hon. Friend’s father was a Health Minister, when the noble Lord Fowler was Secretary of State and when the late Lord Moore was Secretary of State, would he agree that we have had far, far too many of these reorganisations, and that we need to halt the process in our area at the moment?

[Sir Bernard Jenkin]

I will come to that point later; I shall not want to repeat myself.

[Sir Bernard Jenkin]

I was anxious to give way to the hon. Gentleman to show that there is cross-party concern about this matter; I am sure that his point will be enlarged upon by my right hon. Friend the Member for Maidenhead (Mrs May).

All this is being put at risk at a time when the NHS is still reeling from the impact of covid-19. The new Bill will place ICSs on a statutory footing, which is a good thing, but there is also a proposal that the ICS boundaries should be redrawn to be coterminous with upper-tier local authority social care boundaries, and that is what we are questioning.

I am most grateful for the way my right hon. Friend at the Dispatch Box has listened recently to MPs affected by these proposed changes and has consulted us. He therefore already understands why I and others remain so concerned, but I must put it on the record that the rest of the consultation process has been not just inadequate but in defiance of proper transparency and accountability.

[Sir David Amess]

Absolutely outrageous!

[Sir Bernard Jenkin]

My hon. Friend says that is outrageous.

A firm of organisational consultants, Tricordant, was instructed by NHS England and NHS Improvement East of England to host roundtables in recent months with all the stakeholders in and around the NHS in the east of England. For some reason, it was told to exclude the MPs. Tricordant has produced several drafts of its report, which have been shared among existing ICS leaderships, NHS providers and tier 1 local authorities, but not with MPs. A few of us were eventually briefed by NHS England at the Minister’s behest, but I am mystified as to why we were not positively engaged at the outset.

The White Paper produced in February 2020—incidentally, just as we perhaps should have been anticipating the pandemic, instead of planning an upheaval of the NHS—talks about this coterminosity of boundaries, but it also has a whole section on the primacy of place. I will explain this, but those two objectives are fundamentally incompatible. The consultation exercise then appears to have been driven by that dogmatic insistence on coterminosity, and has been further confused by a lack of clarity about the problem that actually needs to be solved.

In Essex and Suffolk, areas larger than single counties were ruled out so Ministers will be presented only with a choice between the boundaries as they are and two county ICS areas—one for Essex and one for Suffolk. Discussions concerning the future of the Suffolk and North East Essex ICS have been strongly weighted towards the county councillors and their officers. Not all relevant NHS stakeholders have been consulted, which is why NHS Providers, which represents NHS leaders across the country, has spoken out on their behalf. Individual NHS leaders are understandably reluctant to criticise proposals in public, but they are known to be against the change, including the leaderships of the acute trusts across the east of England.

I understand why the county councils want this change, and I completely respect their ambition. Essex has made clear to me its frustration at making time for meetings with three different ICSs. I can also see that the new boundaries are superficially attractive, because they align NHS commissioning with the boundaries for the health and wellbeing board and other statutory public services, such as the Essex police and the local resilience forum. Essex County Council acknowledges the extremely successful place-based working implemented by Suffolk and North East Essex ICS, which incidentally has been complimented by the Care Quality Commission, the King’s Fund and the National Audit Office.

The new legislation is intended to extend place-based working to all areas. None the less, the Tricordant report would be misleading if it did not express the clear preference of NHS leaders in Essex to retain the existing ICS boundaries, primarily in recognition of the long history of operating as a single health economy, the significant flow of patients across the county border, the strength of existing relationships in the system, and the progress that has been made locally in integrating health and care services.

There are practical difficulties with the changes for Harwich and North Essex, which are replicated in other parts of England. Enablers of effective place-based working—the leadership, the philosophy and having all the partners sitting around one table—are essential to build effectiveness. A place—I use that term advisedly—that has thrived as part of one system will not necessarily thrive as part of another. Superb progress has been made in north-east Essex in recent years and, more recently, in mid and south Essex. These systems are now working not just because commissioning reflects what is called place but because people have grown into their roles and developed relationships of trust across different organisations. All that will be discarded by the wholesale changes to NHS commissioning by imposing coterminosity.