Background and introduction
1. The commitment was given to Parliament, during consideration of the Health and Care Act 2022, that every integrated care board (ICB) would identify members of its board – i.e., any member with voting rights at meetings of the board of the ICB – which would have explicit responsibility for the population groups and functions set out in this guidance:
- Children and young people (aged 0 to 25)
- Children and young people with special educational needs and disabilities (SEND)
- Safeguarding (all-age), including looked after children
- Learning disability and autism (all-age).
- Down syndrome (all-age).
Please note that when referring to ‘children and young people’ throughout this document, this covers ages 0 to 25 and refers to babies, children and young people.
2. These executive leads support the chief executive and the board to ensure that the ICB functions effectively, in relation to the groups above. These executive leadership roles are added to the statutory requirement for each ICB to include at least one mental health lead (see Annex A for further detail on mental health lead roles).
3. These leadership requirements were created with the intention to secure visible and effective board-level leadership for addressing issues faced by the groups outlined above, and to ensure that statutory duties related to safeguarding and SEND receive sufficient focus. Leaders in these roles will therefore act as both decision-makers and the board-level contact point for the ICB, which will be vital in helping to reduce the inequalities experienced by people in these groups. These individuals will be a key contact point for NHS England regional and national teams and local partners across health, social care, housing, youth justice, criminal justice, education, and regulators, including the Care Quality Commission and Ofsted.
4. Considering this, ICBs must assign these responsibilities to suitable board members. While we would not expect all the roles to be performed by the same person, there is no requirement for them to be separate individuals and there may be a strong rationale to combine some of the roles. We expect those responsible to have suitable experience and sufficient capacity to meet the responsibilities required within their wider portfolio. ICBs should be open and transparent about who holds these roles and should make this information publicly available.
5. The executive lead should work with the board to establish appropriate governance arrangements, so ICB functions are carried out appropriately and in the interests of all groups specified above, ensuring clear lines of communication to and from the board.
6. ICBs should also work with key partners to decide how their arrangements work best across systems and places to support the needs of these population groups, including how best to work together with local authorities at different system levels. This may involve linking governance arrangements, workstreams, and networks, to ensure an adequate flow of information; identifying where there may be gaps; and appropriately delegating responsibilities.
7. Executive leads will have a good understanding of relevant law, policy, guidance, good practice and work closely with local authorities and wider partners, promoting integrated working for the benefit of these population groups. This would include:
- joint working
- delegation of functions
- pooled funds; joint appointments
- any other legal or best practice requirements partners are implementing that may benefit from coordination across an Integrated Care System (ICS)
8. Executive leads should ensure national and local health priorities are considered in the integrated care strategy led by the Integrated Care Partnership (ICP), the joint forward plan led by the ICB, and any local plans and strategies developed by places and health and wellbeing boards in relation to these population groups and their needs.
9. This statutory guidance is intended to set NHS England’s expectations about fulfilling these executive lead functions and outline the responsibilities of these roles in more detail. As well as ICBs and assigned executive leads, this guidance will be relevant to:
- the public
- NHS providers
- commissioners and professionals within health and social care services
- local authorities
- voluntary, community and social enterprise (VCSE) organisations
Children and young people
Executive lead for children and young people
10. Each ICB must have a board-level executive lead for children and young people. The ICB must consider how the board balances perspective, skills, experience and knowledge across board members.
11. The ICB executive lead for Children and Young People will lead on supporting the chief executive and the board to ensure the ICB performs functions effectively and in the interests of children and young people, including but not limited to:
- championing and working in co-production with children, young people and families
- ensuring the ICB articulate in their joint forward plan, how they will meet the needs of children and young people, with a focus on improving their physical and mental health outcomes and reducing inequalities which is a legal duty
- maintaining an overview of the quality of services for children and young people, and the impact these services have on outcomes for children and young people and their families/carers
- ensuring appropriate resources are allocated to children and young people for the provision of services, including the transition to adulthood and joint funding with key partners, e.g., social care, education, police, and Youth Offending Services
- leading the relationship with key partners across public health, social care, justice and education while working through the governance structures of the ICS (e.g., the ICP, place-based partnerships, provider collaboratives, and VCSE organisations) as regards children and young people. Key partners will include directors of children’s services, lead members of children’s services and directors of public health
12. The NHS Long Term Plan set out the vision for an NHS focused on improved outcomes for children and young people. Each ICB is receiving funding from the Children and Young People’s Transformation Programme to deliver the commitments in the NHS Long Term Plan. The executive lead should have a line of sight of delivery of all children and young people commitments led by the ICB, such as mental health, safeguarding, learning disability and autism, health and justice, SEND, and improving outcomes for babies (for example, through implementing the recommendations of the neonatal critical care review or work of the Local Maternity and Neonatal System [LMNS]). They should also contribute to the leadership of wider system work to help keep children healthy and well, for example, through the Healthy Child Programme.
13. As outlined in the National Health Service Act 2006 (as amended by the Health and Care Act 2022), each ICB has a legal duty to involve the public in planning, proposals, and decisions regarding NHS services. Executive leads should ensure the ICB works in co-production with children and young people and their parents, carers, families and representatives to understand issues which affect children and young people. They should also work with local partners to improve outcomes. Recent NHS England statutory guidance outlines ICBs’ legal duties for public involvement in more detail, and provides general support on how to meet them.
Executive lead for children and young people with Special Educational Needs and Disability (SEND) [0-25]
14. The ICB is statutorily accountable for its functions in relation to SEND and is legally responsible for delivering its duties as set out in relevant legislation, including its broad functions under the National Health Service Act 2006 (as amended by the Health and Care Act 2022), and its specific functions in relation to SEND under Part 3 of the Children and Families Act 2014, as set out in the SEND code of practice (2015). The ICB’s functions in relation to SEND include close cooperation with the local authority, and establishing multiagency working requirements and joint commissioning arrangements with local authorities.
15. Each ICB must have a board-level executive lead for children and young people with SEND. The ICB executive lead for SEND will lead on supporting the chief executive and the board to ensure that the ICB performs its functions effectively in the interests of Children and Young People with SEND (0-25). This executive lead is expected to play a strategic role in supporting the ICB, including implementing any actions following the SEND Review Green paper consultation in line with the SEND and alternative provision improvement plan.
16. Key areas of work for SEND executive leads will include but not exclusively:
- Supporting the ICB chief executive and the board to ensure the ICB meets the health requirements of the Area SEND inspections: framework and handbook. The executive role will need to oversee and ensure the delivery and alignment of priority action plans, to resolve areas of improvement identified with partners through inspections/revisits. They will report to the ICB board/committees on the impact at place and on the wider health and social care system, ensuring that the board can monitor progress.
- Ensuring sufficient support, capacity and resource for the role of designated officers for SEND – currently named designated clinical/medical officer (DMO) – to fulfil the role within the ICB and at place, in accordance with the current code of practice. This will involve working with NHS England to review roles and functions.
- Ensuring that there are appropriate information sharing arrangements in place between the ICB and relevant partners and organisations to support the development, implementation and monitoring of SEND data dashboards, and effective joint commissioning.
- Ensuring existing oversight and system quality processes support effective delivery of the ICB’s SEND statutory duties, including Education Health and Care Plan timelines, and quality and annual reviews. The following may help achieve this: NHS oversight framework 2022/23; National Guidance on System Quality Groups; and annual data on education, health and care plans.
- Ensuring effective co-production and engagement while working closely with children and young people with SEND, their families and local parent carer forums. This will ensure the experiences of SEND provision are understood and used to improve service provision.
- Ensuring that interdependencies with SEND (0-25) are aligned and visible within other NHS programmes, while being reflected in ICB governance structures where appropriate, i.e., Children and Young People transformation, safeguarding, learning disability and autism, mental health, transition, Continuing Care/Healthcare, and the Healthy Child Programme.
- Working in partnership with operational and strategic leaders in health, education, social care, parent carer forums, provider collaboratives, local authorities, and VCSE organisations, to drive quality improvement and outcomes for children and young people with SEND and their families.
- Ensuring there are effective joint working and funding arrangements in place across both education and health and care to make case by case health funding decisions with oversight of quality and safety of nursing/clinical interventions in line with the relevant legislation and guidance, including annex 3 of the ‘high needs funding’ operational guidance and relevant NICE guidance.
Executive lead for safeguarding
17. The ICB is statutorily accountable for its functions concerning safeguarding and for aligning to the NHS England’s Safeguarding Accountability and Assurance Framework (SAAF). The purpose of the SAAF is to outline the safeguarding roles and responsibilities of all individuals working in providers of NHS-funded care settings and NHS commissioning organisations.
18. Developments in the legal framework for safeguarding for both children and adults have created new duties and responsibilities which need to be incorporated into the widening scope of the NHS safeguarding practice. All health organisations are required to operate in accordance with their legal duties and with the SAAF.
19. Regulation and inspection are important in demonstrating safeguarding assurance and accountability arrangements across the health system. ICBs are recognised as a statutory safeguarding partner so inspections such as joint targeted area inspections (JTAI) – that explore how services work together for children in need of help and protection – are pivotal to celebrate best practice and embed new learning.
20. Each ICB must have a board-level executive lead for safeguarding people of all ages. The ICB executive lead for safeguarding will lead on supporting the chief executive and the board to ensure the ICB performs its functions effectively as relevant to Safeguarding. In most cases, the executive lead for safeguarding will be the ICB’s Director of Nursing. A key role of the executive lead for safeguarding will be to ensure that the joint forward plan addresses the needs of abuse victims (including domestic abuse and sexual abuse, whether of children or adults).
21. There may be additional layers of corporate safeguarding capacity to support the executive lead (e.g. where multiple CCGs have merged to create a single ICB). The executive lead may delegate to these corporate leaders to sit on the numerous multiagency safeguarding partnerships, support joint strategic needs assessments, and influence plans for safeguarding within local joint forward plans. Where delegates sit on local child safeguarding partnerships, they must have an appropriate level of authority, as outlined in chapter 3 of Working Together to Safeguard Children (2018). Where delegates sit on local safeguarding adults boards, they should have appropriate skills and experience to ensure that the safeguarding adults board acts effectively and efficiently to safeguard adults in its area, as outlined in chapter 14 of the Care and Support Statutory Guidance.
22. The executive lead and those who they delegate responsibilities to will be supported by designated professionals. Designated professionals are required to have direct access to the ICB executive lead for safeguarding, to ensure that there is the right level of influence of safeguarding on commissioning processes and that any provision is trauma informed.
23. Additionally, NHS providers must have named practitioners promoting robust and professional trauma-informed practice in their providers and ensure safeguarding training is in place, as per the intercollegiate documents for both child and adult safeguarding.
24. See Annex B for details on our assurance processes related to safeguarding.
Executive lead for learning disability and autism
25. Each ICB must have a board-level executive lead for learning disability and autism. The ICB executive lead for learning disability and autism will support the chief executive and the board to ensure that the ICB performs its functions effectively in the interests of people with a learning disability and autistic people.
26. The executive lead will support the board to understand and recognise people’s rights as citizens, championing their needs and aspirations. This will include supporting the board in:
- Developing effective ways to work closely with children and young people, adults, and their families and carers to ensure support is personalised and of high-quality.
- Championing co-production of strategies, policies, service delivery and transformation. Recognising the value of people’s lived experience and knowledge of a learning disability and autistic people.
- Putting people at the centre of decision-making, so local services and their commissioning plans prioritise the needs of people with a learning disability and autistic people.
Key areas of work for the executive lead will include but are not limited to:
- Supporting the board to understand and meet its statutory duties, including in relation to the Mental Capacity Act (2005); the Mental Health Act (2007); the Autism Act (2009); the Equality Act (2010); and the Care Act (2014), as well as any statutory guidance relevant to people with a learning disability and autistic people.
- Supporting the board in addressing the health inequalities that people with a learning disability and autistic people experience, supporting equal access to care across all health services; and improving health outcomes.
- Recognising the value of people’s lived experience and knowledge of learning disability and autism, supporting the ICB to actively seek and act on feedback from autistic people, people with a learning disability and their families (Ask, Listen, Do resources are available to support this).
- Supporting the board in the delivery of Care (Education) and Treatment Reviews, Dynamic Support Registers, and of keyworkers for children and young people with a learning disability and autistic children and young people.
- Supporting the board to develop a strategic plan for people with a learning disability and autistic people with local authorities and wider partners. This should use joint commissioning principles to work together to facilitate appropriate community support, care and housing, enabling people to live well at home rather than in a mental health inpatient setting.
- Supporting the board in planning to meet the needs of its local population of people with a learning disability and autistic people. This will include planning for the recruitment, retention, and training of the learning disability and autism workforce – including supporting the delivery of Oliver McGowan Mandatory Training – and ensuring appropriate assessment and diagnosis pathways.
- Working with primary care networks, place-based partnerships, provider collaboratives, health care providers, local authorities, and wider partners to address inequalities in health outcomes for people with a learning disability and autistic people, in line with the priorities in the NHS Long Term Plan and national LeDeR policy.
- Supporting the board to have effective oversight of, and support improvements in, the quality of care for people in a mental health, learning disability and autism inpatient setting. This includes: processes for ensuring delivery of high-quality care, close to home; oversight of restrictive practices in mental health inpatient settings and strategies to reduce reliance on these; host commissioner arrangements; commissioner oversight visits; and ICB Oversight Panels for Care Education and Treatment Reviews.
Executive lead for Down syndrome
27. Each ICB must have a board-level executive lead for Down syndrome. The ICB executive lead for Down syndrome will lead on supporting the chief executive and the board to ensure the ICB performs its functions effectively in the interest of people with Down syndrome.
The responsibilities of this role include, but are not limited to, the following:
- Supporting the ICB chief executive and the board to ensure the ICB meets the legal requirements of relevant legislation, including the Down syndrome Act (2022) and relevant legislation or statutory guidance. This shall include ensuring that statutory guidance is implemented and considered throughout the ICB’s commissioning decisions and at the system and local level.
- Championing and supporting improvements in outcomes for children, young people and adults who have Down syndrome in the ICB’s area, including having oversight of how the needs of people with Down syndrome are being included in commissioning decisions and how those decisions and commissioning plans are co-produced with people with lived experience of down syndrome.
- Working closely with people with Down syndrome and their families so that their experiences of care, good outcomes, and issues and challenges in accessing the support they need are considered during the design, implementation and commissioning of services.
- Ensuring feedback, concerns, comments and complaints from people with Down syndrome, as well as their families, community groups and organisations – including user-led and self-advocacy organisations – are acted upon in a timely manner at the local level. Ask, Listen, Do resources can help.
Annex A: Mental health lead roles at board level
The Health and Care Act 2022, through amendments to the National Health Service Act 2006, required that the chair of the ICB must approve the appointment of at least one member of the board who has “knowledge and experience in connection with services relating to the prevention, diagnosis and treatment of mental illness.” Any such individual must be an ordinary member of the board, meaning that they cannot be the ICB chair or chief executive.
These mental health lead roles play a critical role in addressing the parity gap between mental and physical health now and into the future for people of all ages.
We have co-produced the responsibilities below with ICS mental health senior responsible officers and programme directors (as part of our Mental Health ICS Development Group), provider chief executive representatives, and NHS England mental health regional colleagues.
The responsibilities of this role include the following:
1. To develop a good understanding of relevant law, policy, guidance and good practice and support the ICB chief executive and the board to ensure the ICB exercises its functions relating to mental health effectively. Its statutory functions include those under the National Service Act 2006 (as amended by the Health and Care Act 2022), the Equality Act 2010, the Mental Health Act 1983, and any other legislation or statutory guidance relevant to people with a Mental Health need.
2. To ensure that national and local mental health priorities are considered in the development of the integrated care strategy led by the ICP and the joint forward plan led by the ICB and its partner NHS Trust and Foundation Trusts, that this is adequately funded and resourced, and that it translates into ambitious strategic and operational mental health plans with clear lines of board accountability. Achieve this through the following:
- Oversee and support mental health leaders to be decision making members in ICB and place level leadership when allocating resources to deliver care.
- Support and represent views from all aspects of the mental health system, including community and VCSE assets in the ICB. Ensure the VCSE sector is recognised for the key role it plays as part of a mental health system.Ensure that the system builds on the collective skills of the ICS workforce to deliver system mental health priorities and works in partnership with anchor institutions to plan for a sustainable workforce.
- Work with people with mental health needs and their families to ensure the ICB supports the prevention of mental health problems, and high-quality early intervention where required. Furthermore, to work with local system mental health provider collaboratives to support the localisation of care and smooth transitions across mental health pathways.
3. To ensure people are treated as individuals with individual needs and strengths, and that the ICB actively seeks and acts on feedback from people with a mental health need and their families.
4. To ensure that local services and commissioning plans encompass and prioritise the needs of people with mental health needs. Achieve this through the following activities:
- champion their needs and aspirations
- have effective ways to work closely with people and their families to ensure support is personalised
- championing co-production of strategies, policies, service delivery and transformation with people with lived experience
To oversee the effective use of data, ensuring high-quality data is inputted into national datasets to make informed decisions and used alongside local data to design proactive care models for groups that are at risk of developing mental health conditions (based on evidence to reduce health inequalities). Achieve this through the following activities:
- Work with local government partners through Health and Wellbeing boards to ensure mental health needs are embedded in systematic population health analysis to understand in depth population need including the wider determinants of mental health.
- Consider how data and population health management can support evidencing the interaction between physical and mental health outcomes.
6. To ensure effective Quality Oversight Processes are in place to oversee the quality of all inpatient care for people in mental health settings and robust processes for responding to concerns about care, units rated as inadequate and closing units. This work may be carried out in tandem with Director of Nursing/director of quality board roles. There should be oversight of both people from the local population who are placed in a mental health inpatient service which may be located outside of the ICB, but also for all mental health units located in the ICB.
7. To work collaboratively with partners, providers and primary care networks to reduce health inequalities, including supporting access for patients with serious mental illness to annual health checks, and providing outreach services to underserved communities to ensure equal access to mental health services
8. To ensure that the ICB works collaboratively across organisational boundaries and with other commissioners – e.g., specialised commissioning via NHS-Led Provider Collaboratives – to join up commissioning intentions, with a view of having seamless care pathways. Linking with local mental health provider collaboratives will be vital.
1. NHS England has a robust assurance process which will identify if executive leads are not retaining sufficient involvement and oversight of their key areas of responsibility as set out in this guidance. We will influence and support systems in these cases, recognising that governance and operations arrangements need to reflect operational challenges, e.g., the pandemic, and succession planning. We have created tools such as the Safeguarding Commissioning Assurance Toolkit (SCAT) and the Safeguarding Case Review Tracker to assist ICBs in their statutory safeguarding accountability and the delivery against the Safeguarding Accountability and Assurance Framework.
2. The NHS England Chief Nursing Officer (CNO) is responsible for providing overall assurance to the NHS England board on the effectiveness and quality of safeguarding arrangements across England.
3. The NHS National Safeguarding Steering Group (NSSG) coordinates a number of forums and gains assurance and oversight on behalf of the CNO. The forums include several clinical networks who work on key issues (e.g., child sexual abuse and exploitation; looked after children and Child Protection – Information Sharing). The NSSG provides national strategic and system safeguarding leadership, support and advice in the delivery of the SAAF and requires assurance in the form of the S-CAT and safeguarding case review tracker from ICBs.
4. The NSSG annual review process requires the submission of regional annual safeguarding assurance reports. The reports have the dual purpose of providing assurance as well as enabling any themes, common issues, emerging trends and system-wide learning to be identified from across the health system.
5. Regional Chief Nurses carry out quarterly assurance reviews using the Safeguarding Accountability and Assurance Framework (SAAF), which clearly sets out the safeguarding roles and responsibilities of all individuals working in providers of NHS funded care settings and NHS commissioning organisations.
 The guidance to Clinical Commissioning Groups (CCGs) on preparing the ICB constitution states: “The government and NHS England agreed that ICBs will be required to identify named executive board member leads for safeguarding and SEND, and for CYP’s services. These are not new statutory duties or additional board posts, but rather intended to secure visible board-level leadership of these issues.” In addition, commitments were made on board level executive leadership on learning disability or autism, and on Down syndrome. This guidance is being made under section 14Z51(2), where NHS England has a broad power to “publish guidance for ICBs on the discharge of their functions”.
 See section 14Z52(2)(d) of the National Health Service Act 2006.
 See paragraphs 3.45 to 3.48 of the Send Code of Practice (2015)
 Referred in some ICBs as the Chief Nursing Officer
 See section 14Z52(2)(2) of the National Health Service Act 2006
Publication reference: PRN00004