What’s covered by the Health and Care Act 2022?

The Act, passed in April 2022, confirmed the creation of statutory Integrated Care Systems (ICSs), Integrated Care Boards (ICBs) and Integrated Care Partnerships, which will be formally established on 1 July 2022, at the same time as abolishing Clinical Commissioning Groups (CCGs).

The Integrated Care Board (ICB) will take on the NHS commissioning functions of CCGs as well as some of NHS England’s commissioning functions. It will also be accountable for NHS spend and performance within the system.

NHS England has agreed ICBs constitutions and will hold them to account for delivery.

The landscape for the NHS and its partners is made up of four interlocking elements:

• place, which for most areas (but not all) will usually be based on local authority boundaries.
• provider collaboratives, bringing together NHS trusts and foundation trusts to work more closely with each other to reduce unwarranted variation and inequality in health outcomes, access to services and experience and improved improve resilience by, for example, providing mutual aid. There are already eight NHS led Specialised Mental Health Provider Collaboratives in the South East
• integrated care systems (ICSs),bringing together commissioners and providers of NHS services with local authorities and other partners to plan and manage services that benefit from being considered at greater scale than can be undertaken at place
• the national and regional bodies, including NHS England, the Care Quality Commission (CQC) and the Department of Health and Social Care.

The commissioning responsibilities for primary care services and some specialised services will transition to ICBs.

Staff who were employed by CCGs will transfer to ICBs, and NHS England has made an employment commitment to staff to provide stability and minimise uncertainty.

Each area will also have an Integrated Care Partnership (ICP), a joint committee which brings together the ICB and their partner local authorities, and other locally determined representatives (for example from health, social care, public health; and potentially others, such as social care or housing providers).

The ICP develop a strategy to address the health, social care, and public health needs of their system, and being a forum to support partnership working. The ICB and local authorities will need to pay regard to ICP strategies when making decisions.

The ICB and ICP will also have to work closely with local Health and Wellbeing Boards as they have the experience as ‘place-based’ planners (HWBs act as a forum in every local authority with adult social care and public heath responsibilities. Leaders from the local health and care system could work together to improve the health and wellbeing of their local population)

The ICB will be required to have regard to the Joint Strategic Needs Assessments and Joint Local Health and Wellbeing Strategies produced by HWBs.

Key measures in the Act:

• The NHS and local government coming together to plan health and care services around their patients’ needs including moving services out of hospitals and into the community, focusing on preventative healthcare.
• The Secretary of State for Health and Social Care will have powers to direct NHS England and to decide how some other health services are organised, to transfer functions between some of the arms-length bodies that lead, support and regulate healthcare services in England, and to intervene in proposed changes to the way health services are delivered.
• The development of a new procurement regime for the NHS and public health procurement, informed by public consultation, to reduce bureaucracy on commissioners and providers and reduce the need for competitive tendering.
• Oversight and accountability through new assurance measures in social care providing for the Care Quality Commission (CQC) to assess how local authorities deliver their adult social care functions; data sharing between the NHS and social care; updating the legal framework to enable person-centred models of hospital discharge, and introduce improved powers for the Secretary of State to directly make payments to adult social care providers where required.
• Public health measures relating to food advertising and water fluoridation.
• The establishment of the Healthcare Safety Investigation Branchas a statutory body, and make changes to the system of medical examiners.
• The measures were previously introduced in the Health Services Safety Investigations Bill [HL Bill 4]in October 2019 and earlier draft legislation in 2017.
• Other matters covered by the Act include the regulation of healthcare and associated professionals, the introduction of medical examiners, the collection and sharing of data (including measures to support the development of new medicine registries), international healthcare, the regulation of advertising of unhealthy food and drink, hospital food standards, and fluoridation of water supplies.

NHS England Guidance

The Integrated Care Systems Design Framework was published to support the ongoing progression and development of ICSs. It sets out how NHS leaders and organisations were asked to operate with their partners in ICSs.

In the drafting of this framework NHS England and NHS Improvement talked to a wide range of stakeholders including those representing patient voices, clinical and professional leaders, local government and many more.