“Integrated Care Systems”
Scroll down this page for:
1: “Integrated and Caring”? Definitely not.
2: The NHS Long Term Plan (2019) and the White Paper (2021)
3: ….and the views of campaign groups
4: National KONP responds to the Government
⇒ Sign the “We Own It” and “Keep Our NHS Public” petitions
⇒ Email Councillors and MPs
⇒ Liaise with political groups and trade unions (model motions)
⇒ Circulate leaflets online
7: Map of “North East and North Cumbria ICS”
8: NHS “Consultation” on ICSs
9: “STPs” and “ACOs” – remember them?
“Integrated and caring”? DEFINITELY NOT.
More like “UNDERFUNDED, UNDEMOCRATIC, UNFAIR, UNSAFE”…..
This Spring 2021 we are facing the introduction of parliamentary legislation designed to confirm what are known as “Integrated Care Systems” as “NEW NHS BODIES”. These will divide up the NHS into approx. 42 pots of money with limited ‘population health budgets’ designed to find more ‘efficiency savings’ or as we know it – CUTS. The number of commissioning organisations would be reduced from almost 200 to just 42 ICSs – this requires merging (and eventually abolishing) local “Clinical Commissioning Groups” (established as public bodies by the Health & Social Care Act 2012).
Here, in the North East, we sit within the “North East and North Cumbria Integrated Care System”, which covers a huge geographical area from Cumbria in the west, to Berwick in the north and to Whitby in the South – see map below. This (and a number of other ICSs across England) is already in place as a partnership organisation, but without legal status and statutory powers, and with no public accountability; if the proposals of the white paper are enacted, then this huge organisation would have statutory powers.
One of the major objections we have to ICSs is that they will lead to increased privatisation. Proposals for this top-down re-organisation include tight financial control from the centre and with even less public accountability. The result will be massive new opportunities for private companies through the ‘Health Systems Support Framework’ (HSSF) – set up to facilitate easy contracting by ICSs. The Framework consists of organisations accredited by NHS England to support the development of internal structure and management of ICSs, and, potentially, also to play a long-term role in direct management of ICSs. A quarter of the 83 organisations approved by NHSE to take on contracts with ICSs, and potentially also take seats on decision-making Boards of ICSs are American-based, offering expensive data-based systems designed to benefit US insurance companies and private hospital chains.
Additionally, NHS England argues that existing law, such as the Health and Social Care Act (2012), does not provide a sufficiently firm foundation for the work of ICSs, so they propose scrapping Section 75 of the Act, which, for example, requires commissioners to put any contract worth over £615,278 out to tender. Removing Section 75, by itself, won’t reverse the marketisation of the NHS. Worse still, it would involve revoking Procurement, Patient Choice and Competition Regulations, so turning the NHS into an unregulated market.The proposals also recommend that NHS services be removed from the scope of the Public Contracts Regulations 2015, allowing commissioners more discretion when procuring services. It means that ICSs would be able to choose whether to award a contract directly to a provider or go through a more formal procurement process. Such flexibility massively increases opportunities for cronyism.
It remains clear that ICSs will be instrumental in further developing privatisation and, indeed, opening up the NHS to very large-scale (ICS-size) takeovers by multinational corporations and institutions.
A second major objection we have to ICSs is the lack of democracy and accountability; there will be little scrutiny by our local Councils and it will be much more difficult to oppose any decisions to ration NHS services or deny access to care. The huge ICS organisation would be more remote from the needs and concerns of any local community. This point has been powerfully argued by the all-party Local Government Association (LGA), which represents the leaders of 335 of England’s 339 local authorities. Their response (29th December 2020) to the recent consultation states:
“We are concerned that the changes may result in a delegation of functions within a tight framework determined at the national level, where ICSs effectively bypass or replace existing accountable, place-based partnerships for health and wellbeing…. Calling this body an integrated care system is to us a misnomer because it is primarily an NHS body, integrating the local NHS, not the whole health, wellbeing and social care system.”
ICSs will be statutory NHS bodies and, as such, limited in their ability to work in partnership with others, such as with local authorities in addressing health inequalities.
“In contrast to local authorities, ICSs are not subject to democratic control. NHSE’s proposals will give them the power to create publicly unaccountable joint committees, potentially including representatives from private business, to make legally binding decisions about major resource allocation and service provision….Although ICS Boards will supplant existing public bodies, there appears to be no requirement for them to meet in public, publish their Board papers and minutes, be subject to the Freedom of Information Act, or to have any democratic participation from the communities they cover.” Keep Our NHS Public comment is here
Thirdly, KONP rejects the assumption, repeated frequently throughout ‘Integrating Care’, that social care might be managed through NHS ICS structures. KONP campaigns for a publicly provided national care and support service. At local level, we argue it is essential that social care continues to be managed by local authorities, retaining essential links to wider local authority responsibilities such as housing, education and leisure.
In its response to NHSE’s proposals, the Local Government Association (the national voice for local government) raises concerns that ICSs won’t be a partnership of equals across the broader health, wellbeing, and social care system. Instead, ICSs will be NHS-led, allowing a power grab that brings LA resources such as capital assets and funding for social care and public health under ICS (and thus NHS) control. There is also a risk that power won’t be devolved to local systems. Rather, central control will remain, with missed opportunities for real collaboration between the NHS and LAs to address the wider determinants of health, such as affordable housing and a safe environment. Local Government Association response is here
Integrated and caring? Definitely not.
“Our concerns, based on hard facts, are widely shared by councillors, senior NHS management, GPs and seasoned analysts. NHS England’s proposed changes threaten to make the NHS less locally responsive, less accountable, more dominated by US and other management consultants and contractors, and more focused on policing cash limits than meeting the needs of patients. NHS England’s priorities should be on strengthening the NHS in alliance with local government and communities, not creating new remote bodies or adopting systems meant to maximise profits of private health insurance” National KONP, January 2021
“It is really important to understand that ‘integration’ as in Integrated Care Systems means ‘disintegration’, centralisation, loss of public accountability, opening door wider to private companies, driving down quality to reduce costs, rationing, and a fundamental shift way from a universal service providing comprehensive care to all, free at the point of use” Dr John Puntis, KONP Co-Chair, 7th February 2021 here
“These proposals are incoherent, de-regulatory, off-target, and badly timed. They will do next to nothing to remedy the serious shortcomings highlighted by the pandemic: a depleted NHS, a privatised social care system, with over-centralised, fragmented and part-privatised communicable disease control and public health systems. Joined-up legislation is needed to revitalise local authorities and to rebuild public services” Professor Allyson Pollock and Dr Peter Roderick, Newcastle University, 11th February 2021 here
“The NHS is not a ‘religion’, as some would sneeringly suggest, but a hard-won right to receive medical care unconditionally when we are in need. It’s a right that we are losing fast, and which will be gone if the White Paper turns into legislation” Deborah Harrington, Public Matters, 12th February 2021 here
THE NHS LONG TERM PLAN (2019)
This far-reaching, top-down reorganisation of the NHS is based on the proposals in the Long Term Plan – click here for details
….and THE WHITE PAPER (2021)
….AND THE VIEWS OF CAMPAIGN GROUPS
and, now, please click the links below for another view.
We feel that the proposed “Integrated Care Systems” (or “Accountable Care Organisations” as they are known in America) have no place in our NHS. These two videos and the articles that follow further clarify the situation we face in 2021….
– National KONP: An overview of the Governments White Paper proposals and why we need to campaign against these proposals can be found here
– BBC News: Click here. Keep Our NHS Public’s John Lister on how the Government spin on its white paper is false. The crisis has revealed more and more privatisation and outsourcing plans, not less.
– RT News: Click here. Keep Our NHS Public’s co-chair Tony O’Sullivan on why the Government it really trying to force through NHS reorganisation now, in the middle of the pandemic. And reversing privatisation is not the reason.
– Many thanks to KONPNE Steering Group member John Kennedy, who has brought together some of the main themes, proposals and questions in his paper here.
We Own It (7th April 2021) More privatisation, less accountability – this government’s plans for the NHS
National KONP (18th February 2021) 2021 NHS White Paper: government seizes on the pandemic as an opportunity
National KONP (6th February 2021) Government used crisis to increase privatisation – NHS white paper will endorse
National KONP (January 2021) Integrated Care Systems Summary Briefing
Click here for many links to articles about ICSs at “The Lowdown.”
999 Call for the NHS (January 2021) Integrated Care – the US Danger
999 call for the NHS (7th January 2021) We say NO! to proposed NHS legislation that would restrict access to care and profit global companies
National KONP responds to the Government
Keep Our NHS Public was provided with an opportunity to present evidence on the proposals put forward in the Government’s White Paper “Integration and Innovation: working together to improve health and social care”. Here is what National KONP said to Parliament.
We have a number of concerns about these proposals, namely:
– The risk of a democratic deficit
– Increased central control despite assurances of more local decision making
– The risk of prioritising constraint over collaboration
– A shift of focus for the NHS from the provision of universal, comprehensive care towards ‘demand’ management
– The risk that mere lip service will be given to redressing health inequalities
– The increased presence and influence of private companies facilitated by Integrated Care Systems
– The implications of repealing Section 75 of the Health and Social Care Act (2012) without dismantling the market in NHS services
– The emphasis on deregulation at the risk of cronyism
– New arrangements that will fragment and deskill the NHS workforce, with the possibility of deregulating some professions in future
To read the entire document of evidence submitted by KONP
⇒ Sign the “We Own It” and “Keep Our NHS Public” petitions
⇒ Email Councillors and MPs
⇒ Liaise with political groups and trade unions (incl model motions)
⇒ Circulate leaflets online
We need your help now to:
>> demand an immediate halt to the rollout of ICSs.
>> demand extended and meaningful consultation with the public and Parliament to decide how health and social care services are provided in England.
>> promote the introduction of legislation to bring about a universal, comprehensive and publicly provided NHS, fit for the 21st century (as set out in the NHS Bill at www.nhsbillnow.org)
Please read on, get involved with the Campaign, and let us know how you get on….we’re at firstname.lastname@example.org
⇒ SIGN THE “WE OWN IT” and “KEEP OUR NHS PUBLIC” PETITIONS
The government have recently announced NHS reforms, and you may have been delighted to see them being discussed as reducing the role of the private sector in England. But the reality is that these reforms will mean MORE American-style privatisation of our health service. These plans will give private companies BIGGER roles in decision-making and MORE contracts without any checks and balances. This government is hellbent on involving the private sector in our health service further. But they know this isn’t popular. That’s why they’re putting this spin on these reforms. It’s smoke and mirrors.
These new plans would: 1) Allow private companies like Deloitte to sit on boards that make decisions about how to spend NHS money 2) Introduce the American model into our NHS where unaccountable decision making bodies prioritise profit margins and making savings over caring for people’s health. This model is likely to lead to cuts and closures of NHS hospitals and A&E 3) Push more people to go private as cuts are made. Patients have already been promised greater rights to choose private treatment and have it paid for by the NHS 4) Open the door to more cronyism – yet more contracts would be given to government pals like Serco, as we’ve seen in the pandemic, but without any competition – that’s what the government means by ‘reducing bureaucracy’ 5) Encourage private companies to take the NHS to court if they’re unhappy.
What we actually need is a national high quality, well funded, public NHS for everyone. 3 out of 4 of us want our NHS reinstated as a fully public service after the pandemic. We want an NHS run for the public, not profit. And we are going to fight for it.
To sign the “We Own It” petition
The NHS in England is rapidly being reorganised into 42 regional Integrated Care Systems (ICSs), while the Covid pandemic rages. These ICSs will strengthen the role of private companies, including US health insurance corporations, in the NHS. NHS England has asked for legislation to support the role of ICSs and turn them into legal bodies.
This must be stopped. We demand an immediate halt to the rollout of ICSs across the English NHS. ICSs represent a major reorganisation of the NHS, which will have far-reaching consequences for patients and staff. We demand an extended and meaningful consultation with the public and Parliament, to decide how health and social care services are provided in England.
To sign the “Keep Our NHS Public” STOP THE ICS ROLL OUT petition
⇒ EMAIL YOUR COUNCILLORS and MP
It will take around 15 minutes to email your local Councillor and MP, requesting that s/he is proactive in supporting the campaign to halt the immediate roll-out of the ICS. Please feel free to highlight some of the issues identified above, and ask for a response to your email.
If you wish, please feel free to copy the letter here.
The names and email addresses of your ward councillors can be found on your Councils website; if you already know the names of your local councillors, then their email addresses are listed on our links page here. The email addresses of all North East MPs are located on the same page here. If possible, please also copy in the Chair of the Councils Health and Wellbeing Board, and the Chair of the Councils Health Scrutiny Committee – they can be identified through your Councils website, and their email addresses can be found on our links page. For good measure, please also copy in your local Healthwatch group – on our links page.
This is democracy in action – please ensure that your voice is heard.
⇒ LIAISE WITH POLITICAL GROUPS & TRADE UNIONS (incl model motions)
Whilst our members support a range of political organisations and parties (or none), we are clear that KONPNE as a campaign group is not aligned to any trade union, political party or organisation. Our attention is focused solely on the NHS, and KONPNE members come together to actively campaign for a publicly funded, publicly provided and publicly accountable NHS. We are happy to report on any initiatives that fit with these beliefs. With regards to the ICS, it would help greatly if supporters liaise with any political groups or trade unions they may be a member of – it is crucial that they hear your views about these issues
“Oppose Integrated Care Systems in the English NHS: Model motion for trade unions” – click here
“Oppose Integrated Care Systems in the English NHS: Model motion for Labour branches and CLPs” – this can easily be adapted for use by other political parties and organisations – click here
Much respect to Morpeth and Pegswood Branch Labour Party. “Oppose Integrated Care Systems in the English NHS”, the above motion, was debated and was unanimously passed by the Branch at their meeting in mid-March 2021. It was clear that what is needed is legislation to bring about a universal, comprehensive and publicly provided NHS, fit for the 21st century… It is great that this motion is supported in Morpeth and by many other Branches and CLPs – and, indeed, by other political parties, Unions and organisations throughout England. Not yet passed by your group? Please do everything you can to move this forward. THE PROPOSED ICS LEGISLATION MUST BE STOPPED.
Click here to listen to Margaret Greenwood MP : “I’ve called on the government to pause its plans for a major reorganisation of the NHS. It’s just plain wrong in the middle of a pandemic when staff are exhausted and public meetings can’t take place” 24th February 2021.
The following excerpt is from the Labour Policy Forum, 3rd February 2021. The Health and Social Care Policy Commission develops Labour policy and thinking on areas including the future of the NHS, mental health, public health and social care.
“Although successive Labour Party conferences since 2016 have voted to actively oppose NHS England’s integrated care systems and Long Term Plan, Labour has not yet implemented this policy. It was therefore very good news that at the Health and Social Care Commission on 27.1.21, Jonathan Ashworth (accompanied by Rosena Allin-Khan) committed labour to actively repeal all legislation enabling or supporting integrated care systems. This should now be urgently translated into action by all members of the shadow front bench, the PLP and Labour councillors, to actively oppose all national and local arrangements and/or policies aimed at facilitating integrated care systems and/or facilitating the Long Term Plan (LTP). It has been clearly established that the LTP originated in papers drafted by McKinseys at the Davos World Economic Forum in 2012. The overall aim was to undermine and eventually privatise public health care systems throughout the world. Successive governments have developed proposals of this sort since the 1980s; NHS England’s forthcoming proposals for legislation on integrated care systems will finally achieve it unless Labour actively opposes this”
Alex Scott-Samuel, 3rd February 2021: click here
⇒ CIRCULATE LEAFLETS ONLINE
Whilst printing out and circulating paper copies is definitely not advised at this time of Covid19, it is still possible for us all to save these leaflets to our devices and copy or link them to friends and contacts…
A4, 2 sided info sheet: click ICS info sheet A4 2021
or click on
A5, 2 sided flyer leaflet: click ICS flyer leaflet A5 2021
or click on
We Own It (11th May 2021) 16 organisations call for NHS Bill to be halted
Socialist Health Association (10th May 2021) Centene: The real agenda
Bright Green (27th March 2021) Matt Hancock’s proposals for our NHS are bad news
Private Eye (March 2021) A Practice Run
The Lowdown (21st March 2021) Bleak prospects for troubled ICSs
Laura Murrell, Secretary, KONP Sunderland and District re “Consultation” Click here (obviously some “consultation” responses are more equal than others…..)
Twitter (16th March 2021) Hancock talking about ‘the false dichotomy’ between public and private… and equating GPs with companies like Virgin Click here
The Lowdown (6th March 2021) Can campaigners unite over coming health Bill?
Labour Outlook (26th February 2021) Hancock’s NHS plans would see the ramping up of privatisation on a scale we’ve never seen before
The Lowdown (24th February 2021) The great consultancy boom – from Covid to ICSs
The Canary (16th February 2021) The reasons why Matt Hancocks proposed NHS reforms should worry us all
Tribune (12th February 2021) The Next NHS Sell-Off
British Medical Journal (11th February 2021) A new bill to reform the NHS in England: the wrong proposals at the wrong time (Prof Allyson Pollock and Dr Peter Roderick)
Stewart Player, National KONP (2021) Integrated care or healthcare imperialism?
Guardian (11th February 2021) Matt Hancock to publish plans to give ministers more power over NHS
Mirror (11th February 2021) Tories unveil plans today to unpick their own disastrous NHS reforms
Dr John Lister: “We have another massive top-down reorganisation which retains the fragmentation and chaos of outsourcing…leaves huge contracts to be allocated without any competition”
Morning Star (11th February 2021) All spin and no substance in Tories’ health and social-care plan, Unions and NHS campaigners warn
rs21 (10th February 2021) Are the Tories really reversing NHS privatisation?
Institute for Government (8th February 2021) Leaked NHS reforms would take us back to the wrong sort of future
The Lowdown (9th February 2021) White Paper: power grab, sea change or cementing in the status quo?
Duncan Poundcake (5th February 2021) #NHS Not all Privatisations are equal, some are worse and some are Evil…
Health Service Journal (27th January 2021) CCG mergers must still go ahead in April, says NHS England
The Lowdown (8th January 2021) Councils concern about NHS shakeup
Chronicle (17th December 2020) City leaders back groundbreaking new partnership to transform health and social care services
CK 999 Call for the NHS (14th December 2020) US companies poised to run NHS following proposed legislation
The Lowdown (6th December 2020) NHS England pushes for “integration” … but not as we know it
KONP (10th December 2020) Dangerous NHS restructuring to go ahead despite Covid
The Guardian: Years of underfunding leave NHS ‘woefully short’ for Covid second wave (5th November 2020)
CCG mergers > ICSs: The Lowdown (September 28th 2020)
Who’s cashing in on ICS’s? The Lowdown (October 12th 2020)
CK999 Call for the NHS (2nd February 2019) What changes will patients notice when the NHS is run by Integrated Care Systems and Providers?
Further detailed analysis of the ICS proposals is given in the three part National KONP document (January 2021) linked below:
Part 1: Corporate Agenda for Integrated Care on the themes running through NHSE’s ‘Integrating Care’ including the use of digital and data to drive system working, reform of the NHS payment system, and the influence of multi-national corporates through the NHSE’s Health Systems Support Framework (HSSF);
Part 2: An alternative vision: achieving democratic accountability, addressing the lack of democratic accountability in ICSs;
Part 3: Social care: relationship to ICSs, considering threats to social care from ICSs.
All documents are linked here
NORTH EAST AND NORTH CUMBRIA INTEGRATED CARE SYSTEM (NENC ICS)
> ICS Strategic Five Year Plan: Presentation by Mark Adams to the Councils’ Joint Overview and Scrutiny Committee (20th January 2020) is here
> Map of the North East and North Cumbria Integrated Care System (NENC ICS). This is sub-divided into four Integrated Care Partnerships (ICPs) , with each Partnership area being divided further into places:
NHS “CONSULTATION” ON INTEGRATED CARE SYSTEMS