11 January 2021


The Health Devolution Commission, co-chaired by Andy Burnham and Norman Lamb, has submitted evidence on the future of integrated care. It welcomes NHSE’s proposals as “a major step forward towards its vision of comprehensive health devolution and collaborative ways of working”, but believes “there is a strong case for going further and giving local areas more choice about the nature of their local system in order to deliver better NHS and social care services, and build healthier and more prosperous communities.”

The Commission’s preferred option is that a third “Health and Prosperity” model of Integrated Care Systems is added to the two proposed in the NHSE consultation, which closed on Friday 8th January. It also believes there is a case for dispensing with “the technocratic term” Integrated Care Systems and adopting the title Integrated Care Partnerships to better reflect that the next iteration of reform must be predicated on a genuine partnership between the NHS and local government as well as clinical and third sector stakeholders.

Andy Burnham, Co-chair of the HDC, Mayor of GM and former Health Secretary said:

“The Covid crisis has shone an even sharper spotlight on the struggles of our social care system, which, despite the incredible sacrifices and efforts of many thousands of outstanding staff, I have argued has been broken for a long time. The pandemic has also demonstrated the need for a ‘health in all policies’ approach.

“We must be radical in how we improve the system and build on where local partnerships are already working. That’s why we are proposing a third ‘Health and Prosperity’ model of Integrated Care System bodies. This would extend the two options being proposed and give more autonomy to local ICS bodies to tackle health inequalities. It would also help secure an integrated approach to NHS and social care services as well as improve the health and economic prosperity of their communities. This model also recognises devolution in England and devolving power and budgets to more local and regional areas are the best way to deal with health and social care issues in those areas.”

Norman Lamb, Co-chair of the HDC and former Health Minister said:

“The next iteration of ICS bodies must avoid becoming a technocratic rearrangement of traditional ‘command and control’ in the NHS, predicated on a model in which ICS bodies are clinically led and primarily accountable to NHSE or central Government. The Commission also believes there is a case for dispensing with the technocratic term Integrated Care Systems and adopting the title Integrated Care Partnerships.

The principles of effective integration of health and social care are: a person-centred and co-productive approach; collaborative leadership; subsidiarity – decision-making as close to communities as possible; and a preventative, assets-based and population-health management approach.

“The welcome replacement of competition – as an underlying principle of the NHS to drive health service improvement – with collaboration between commissioners and among providers requires alternative means of ensuring quality. The Commission suggests that the new collaborative approach should be accompanied by both greater local democratic accountability and enhanced external scrutiny.”

The key elements of the Commission’s proposal for an additional and optional joint “Health and Prosperity” model of Integrated Care System bodies are that this would allow them to: 

  1. Embrace a wider purpose to include better social care and public health services, tackling health inequalities and improving economic prosperity 
  2. Embed the principles of person-centred care, active citizen engagement, and ‘health in all policies’ in its ways of working 
  3. Ensure parity of esteem between physical health, mental health, social care and public health 
  4. Enhance local democratic accountability through joint civic and clinical leadership in a ‘partnership of equals’ 
  5. Ensure single health and social care budgets and commissioning at the locality level 
  6. Enable the best alignment of new ICS body footprints with established boundaries of Local or Sub-Regional Government 
  7. Embrace health and social care workforce planning and management 
  8. Establish robust external scrutiny arrangements to ensure quality 

Please click here to read the full response of the Commission.