ICS have been introduced and developed undemocratically, without consultation and with a lack of transparency.  Their aim is to impose ‘reduced per capita cost‘ control totals to force unproven and unsolicited  innovation, including elements of privatisation and paid for care, in each system’s struggle to meet local population need. This has been NHSE/I’s practice with individual Provider Trusts over recent years. Each ICS will form a new Integrated Care Provider (ICP) organisation. NHS England plans for ICP organisations to be managed through commercial contracts. We therefore call on government to ensure that:

  1. Local Authority Scrutiny Committees across England be allowed to fulfil their legal responsibilities to scrutinise fully the significant changes in NHS services that have been initiated without scrutiny under the COVID-19 emergency measures before they become any permanent part of ICS development. If the Committees decide that the changes require full Public Consultation then this must also happen before the changes are allowed to remain. These actions are well established legal process.
  2. Some democratic representation is created in the Governance structures of ICSs by: i) an increase in Local Authority Councillor representation on the Governing Bodies so as to match in numbers the NHS representation (Partnership) and ii) full public engagement and involvement for all significant changes and developments in the NHS, with full Consultation as well on the more major issues as decided by the Scrutiny Committees which have been set up in our democracy for this purpose.
  3. In the longer term there must be a return to universal risk pooling and funding with renewed efforts for National equity of care and National decisions about affordability. ICS must be replaced by Health Boards with the return to geographically based responsibility for the delivery of health to local populations. The apparatus of the market that divides the NHS must be dismantled. Health Boards as public, accountable bodies would plan and provide the full range of NHS services, with participation from elected councillors, community organisations, Neighbourhood Health Committees as advocated in our paper “Public Health and Primary Care” andtrade unions. The quality of services would then be monitored by locally-based independent bodies involving local patients and community groups, with the powers once enjoyed by Community Health Councils.

Dr  Jackie Applebee

Chair Doctors in Unite


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  1. Alex Scott-Samuel says:

    Having had the privilege of proposing the SHA motion at Labour’s 2017 conference (composite 8) and of seconding NHS composite 2 in 2019 – both of which committed Labour to actively opposing the Long Term Plan and ICSs – I fully support these proposals. In 2016 the SHA voted 30-1 to support the NHS Reinstatement Bill, the single vote in opposition being from the current SHA Chair. The SHA and DiU need to assertively advocate for full renationalisation of the NHS, abolition of the ICS and full reversal of the Long Term Plan – hopefully with support from the Shadow health team.

  2. Nicholas says:

    “ICS have been introduced and developed undemocratically,” that’s the key issue indeed. Had democracy got in the way, they would never have happened, as their advocates in all parties and none are well aware.

  3. Gordon Keegan says:

    Democracy doesn’t matter or mean anything to this government. Alex and Nicholas are spot on.

  4. Dag Saunders says:

    Fully agree with Jackie, it’s one of the ways the government is changing structures and control without the need for primary legislation and therefore proper scrutiny.

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