Health scrutiny and “integrated care systems”

Posted on 23/07/2019 by Ed Hammond.

If you are at an county or unitary council then structural change in the English NHS won’t have been far from your mind for much of the last decade. It seems as if there is a near constant round of local variations to health services, accompanied by nationally-led alterations – leading from the establishment of sustainability and transformation partnerships (STPs) to the more recent establishment of integrated care systems (ICSs).

It’s to ICSs that we now turn our attention. Government predicts, and is encouraging, the evolution of STPs and ICSs, so we need to understand what this will mean on a practical level.

Integrated care systems are, fundamentally, a mechanism to bring about closer collaboration between local systems which include local councils. They are about learning from and building on the “new care models” work carried out by the NHS in the 2015, in order to explore and implement different ways of providing services to people in the community and through acute services.

Of course, “different ways of providing services” can mean big changes to local health services, and is the place where health scrutiny comes in. The NHS Long Term Plan sets out that all STPs will convert to being ICSs by 2021; closer integration and collaboration will mean variations to local services across the whole of England.

Health scrutiny has an obvious and significant role in overseeing and holding to account these variations and other changes. Substantively, scrutiny can engage with and challenge some of the assumptions that underpin change and can bring democratic accountability to what might otherwise feel like a technocratic process. Scrutiny also, of course, has its formal role to play around strengthening the voice of local people, ensuring that their needs and experiences are considered as an integral part of the design and delivery of health services.

We’re keen to understand what councils are doing to prepare for these changes – what conversations they may be having with the NHS locally about forthcoming changes, and what expectations the local NHS might have about health scrutiny’s involvement. We are concerned that health scrutiny has been conspicuous by its absence in some of the more recent national publications on this subject (the NHS Long Term Plan doesn’t mention scrutiny at all).

We will probably be asking questions relating to these matters in our annual survey of overview and scrutiny in local government in the autumn, but in the meantime, we want to know your thoughts on the subject – please e-mail .  

About the Author: Ed Hammond

Ed leads CfGS's work on devolution, transformation and on support to councils and other public bodies on governance and accountability.