Developing effective governance around INTs will enable clear accountability, streamlined operations, and equitable delivery. This should include unified governance principles focused on three key areas – Equity, Transparency and Adaptability – with a consistent framework for decision-making whilst allowing locally specific variations. This means:

Core structures and support to enable effective governance across London, with different spatial levels supporting each other in delivering on neighbourhood health services and priorities.

A tiered, integrated governance structure, which brings together clinical, financial, and operational oversight into a single framework. The purpose of this framework will be to build on existing place based partnerships and enable decisions to be made at the nearest possible point to the neighbourhood level, providing clear routes through which anything that cannot be resolved at the lower tiers to be escalated. This will include a set of clear and consistent roles and responsibilities and accountability mechanisms supported by real-time reporting, periodic performance evaluations, and defined escalation protocols. The focus of this approach will be on reducing bureaucratic delays and improved decision-making efficiency.

Neighbourhood governance structures will demonstrate how they empower communities in the planning, delivery and evaluation of care. This includes engaging proactively with communities on developing governance processes to build trust and improve accountability. Structures will support localised decision-making and alignment with system and regional goals, remaining flexible enough to respond to emerging needs, challenges and opportunities, whilst providing the stability needed for long-term planning and consistent care delivery.

Embedding equity into governance structures and processes to ensure that resources are being directed based on population health needs, rather than historical patterns and allocations, and that where there are inequalities identified, an agreed redistribution mechanism is in place to address these at system and place level. There is recognition that this may require additional devolution to London, including “negative devolution” – providing systems and places with additional discretion to prioritise specific local needs, rather than being constrained by national priorities and ring-fencing.

Updated clinical governance and risk management including protocols to oversee care quality and patient safety, particularly during transitions and across interfaces, to mitigate clinical errors, and ensure patient safety across multi-organisation health and care delivery systems.

Clinical governance arrangements, integrated within wider governance, should include ICS clinical governance committees to oversee neighbourhood-level frameworks, ensuring alignment with national standards whilst allowing for local adaptation, and the creation of clinical accountability plans for every INT, (for example, detailing responsibilities across teams and outlining protocols for shared care and handovers).

Integration of clinical, financial, and operational oversight of INTs and the neighbourhood health service into a unified framework. Engaging diverse stakeholders, including residents, ensuring that governance structures reflect community needs whilst remaining efficient. Clear accountability mechanisms are vital to ensure INTs deliver against agreed priorities, with models such as OneLondon reflecting transparent reporting systems and measurable outcomes that can be used to establish progress across London’s place partnerships. These mechanisms will help to promote alignment with system goals and enhance trust among wider organisational stakeholders.

Collaborative governance across all ICBs to manage strategic investment in, and operational delivery of, the foundational data infrastructures required to enable integrated working, including a consistent population-level linked longitudinal data set. This will build on the existing OneLondon Health Data Board, which is tasked with orchestrating and managing shared infrastructures including the developments of OneLondon services, (such as the Secure Data Environment) and the Federated Data Platform in London.

Ensuring visibility across our neighbourhoods, places and systems, including the definition of measurable outcomes that place based partners will target to ensure consistent quality of care, with specific guidance on reducing health disparities across neighbourhoods. This will be enabled by the creation of a public-facing dashboard showing governance performance metrics, such as decision timelines and accountability reports, and supported by annual reviews, led by place partnerships, of their structures to assess alignment with system and local goals and identify areas for local improvement.

A unified set of governance principles to guide INTs across all place-based partners and ICSs in a consistent manner.

These principles will focus on equity, adaptability, transparency, and local empowerment, providing a consistent framework for decision-making whilst allowing neighbourhood specific variations:

• Equity: Defining measurable outcomes that place-based partners will meet to ensure consistent quality of care, with specific guidance on reducing health disparities across neighbourhoods.
• Transparency: Creating a public-facing dashboard showing governance performance metrics, such as decision timelines and accountability reports, building on existing transparency mechanisms in London.
• Adaptability: Requiring place-based partners to produce annual reviews of their governance structures to assess alignment with regional goals and identify areas for local improvement.
• Local empowerment: Governance frameworks that empower neighbourhoods to make decisions that reflect local priorities whilst maintaining alignment with place, system and regional goals. Achieving this balance will be necessary to enable local innovation without creating further unwarranted variation in care quality. This could include establishing neighbourhood panels with local leaders, residents, VCFSE representatives, health and care providers. Examples of where such structures have already been implemented include Brent Integrated Care Partnership’s neighbourhood governance forums, which provide a platform for local decision-making whilst ensuring accountability to ICS-level strategies; and South West London’s task groups, which have formalised local responsibilities within a regional governance framework.

A principles-based approach will ensure governance structures remain flexible enough to respond to emerging challenges and opportunities whilst providing the stability needed for long-term planning and consistent care delivery. This would include introducing regular governance stress tests to evaluate their adaptability to new policies, population health changes, and technological advancements, and agreed protocols that streamline decision-making during crises, ensuring swift action without bypassing accountability structures.

Governance frameworks will ensure equitable access to resources and care across all boroughs, addressing disparities in population health and service quality. As part of new governance models, equity audits should be embedded into governance evaluations, to ensure that resources are being directed based on population health needs rather than historical patterns. Where there are inequalities in resources, a redistribution mechanism, similar to the model piloted in Hammersmith and Fulham, should be in place to prioritise underserved areas or vulnerable populations.

This will include robust risk management protocols to oversee care transitions, mitigate clinical errors, and ensure patient safety across multi-organisation care delivery systems. Shared risk registers will span neighbourhood, borough, and ICS levels, allowing risks to be flagged, monitored, and addressed collaboratively; updated risk management training for boards and operational leaders will help equip them to anticipate and mitigate risks effectively within an integrated neighbourhood context.