1. Introduction

1. The Health and Care Act 2022 (“the Act”) established integrated care boards (ICBs). ICBs are statutory organisations which commission services for their area and work with local services, including local authorities and wider partners, to improve population health and establish shared strategic priorities.

2. Under the terms of the Act, NHS England is required to undertake a performance assessment of each ICB in respect of each financial year and to publish a summary of these assessments.

3. This guidance has been developed together with ICBs. It sets out details of the areas that the annual assessment for 2022/23 will cover, as well as information on timing and process. It should be read in conjunction with other key planning and oversight documents including the NHS Long Term Plan, the NHS Oversight Framework and the 2022/23 priorities and operational planning guidance.

2. Assessment approach and process

2.1 Scope

4. NHS England has a legal duty (Section 14Z16 of the National Health Service Act 2006 as amended by the Health and Care Act 2022) to annually assess the performance of each ICB in respect of each financial year and publish a summary of its findings. In undertaking this assessment, NHS England will consider how successfully each ICB has:

• led the NHS within its integrated care system (ICS)
• contributed to each of the four fundamental purposes of an ICS (the four fundamental purposes of an ICS, set out in Integrating care: next steps to building strong and effective integrated care systems, are: improving population health and healthcare, tackling unequal outcomes and access, enhancing productivity and value for money and helping the NHS support broader social and economic development)
• performed its statutory functions
• delivered on guidance set out for it by NHS England or the Secretary of State for Health and Social Care regarding its functions, with a particular focus on the objectives set out in the priorities and operational planning guidance.

5. The assessment must include, but is not limited to, an assessment of how well the ICB has performed the following specific duties, required under the terms of the Act:

• the duty to improve the quality of services
• the duty to reduce inequality of access and outcome
• the duty to take appropriate advice
• the duty to facilitate, promote and use research
• the duty to have regard to the effect of decisions (The “triple aim”)
• the duty to consult patients and the public about decisions that affect them
• the financial duties
• the duty to contribute to wider local strategies.

2.2 Outcome and timetable

6. The inaugural annual assessment for 2022/23 will take the form of a letter from the relevant NHS England Regional Director to the ICB Chair in response to the ICB’s first annual report and accounts. The annual assessment will:

• summarise areas where NHS England believes that the ICB has demonstrated good or outstanding practice as well as areas of challenge
• detail any support needs that have been identified over the course of the year, any support or intervention that has been implemented in response, and a summary of the ICB’s progress towards any agreed improvement goals.

7. Annual assessments for 2022/23 will be completed and the outcome shared with ICB Chairs by the end of July 2023. The assessment will not include an overall rating of ICB performance.

8. NHS England is required under the terms of the Act to summarise the outcomes of all annual assessments and will include this summary within its own annual report and accounts.

2.3 Assessment approach and process

9. This guidance sets out how the annual assessments will be conducted, including the specific Key Lines of Enquiry (KLOEs) that NHS England will use when making its assessment.

10. The assessment approach for 2022/23 has been developed with ICBs to minimise additional burden and meet the specific requirements set out in the Act. The assessment will therefore draw, wherever possible, on existing processes and information, reducing bureaucracy and avoiding duplication. Assessments will be underpinned by three main sources of evidence:

• The ICB’s own Annual report and accounts
• The outcomes of routine discussions between NHS England and ICBs held over the course of the year
• Feedback from key system partners.

Annual reports and accounts

11. Under the terms of the Act each ICB must prepare an annual report setting out how it has discharged its functions in the previous financial year. This must include an explanation of how the ICB has discharged each of its statutory duties. NHS England will review ICB’s annual reports and use the information supplied through this process to assess how effectively the ICB has discharged its duties.

Routine discussions

12. NHS England and ICBs hold regular discussions throughout the year and the outcomes of these discussions will be used to support the annual assessment. This includes oversight meetings, as described in the NHS Oversight Framework, and the quality governance arrangements described in the National Quality Board guidance on quality risk response and escalation.

Feedback from system partners

13. Under the terms of the Act, NHS England and the ICB must consult with Health and Wellbeing Boards as to how effectively the ICB has contributed to the ambitions set out in the Joint Local Health and Wellbeing Strategy.

14. NHS England will also seek feedback from the integrated care partnership (ICP) as a critical stakeholder within the ICS, having due regard for conflicts of interest.

15. The ICB and NHS England should, as part of routine conversations, consider those stakeholders whose feedback it may be relevant to seek as part of both parties’ annual reflections. This could include:

• NHS trusts and foundation trusts
• primary care providers
• clinical networks and alliances
• local Healthwatch
• voluntary and community sector organisations.

3. Key lines of enquiry

16. The annual assessment will be structured in five sections and consider the overall leadership function of the ICB and its contribution to the four core purposes of an ICS:

• System leadership
• Improving population health and healthcare
• Tackling unequal outcomes, access and experience
• Enhancing productivity and value for money
• Helping the NHS support broader social and economic development.

17. The following table sets out the specific KLOEs that will be considered against the individual themes and duties that form part of the assessment. As part of its review of the ICB’s annual report NHS England will also consider the ICB’s delivery against its wider statutory duties, including those related to choice, children and young people, and safeguarding.

System leadership

Improving population health and healthcare

Tackling unequal outcomes, access and experience

Enhancing productivity and value for money

Helping the NHS to support broader social and economic development

Publication reference: PRN00510