Multiple problems have been highlighted with the leadership and governance of a much-vaunted integrated care system, including a lack of trust between organisations which often hide information that could weaken their position.
HSJ has seen an executive summary of the review of Greater Manchester ICS, which cited widespread concerns around the allocation of resources, confusion about the role of commissioning, and “muddled” governance.
It was conducted by consultancy firm Carnall Farrar, which held interviews and forums with more than 200 leaders in the system.
The report, dated May 2023, also found:
- a lack of transparency and trust between partners, with some only sharing a “partial overview” of performance and finances which drives choices likely to “bias” some organisations;
- complex architecture of system boards, committees and forums, with “muddled” governance, unclear paths for critical decisions to be made, and unclear delegations to localities;
- frustration at the quantum of meetings that take place at system, locality and provider level;
- confusion/ambiguity around the roles and responsibilities of the integrated care and provider federation boards, and particularly around the role of commissioning;
- leaders in some places felt “the ability to make progress at ‘place’ had gone backwards”; and
- many partners felt delivering the overarching strategy for the system (to improve population health) is conflicting with achieving financial balance and meeting NHS targets.
Greater Manchester is still often seen as a leading ICS, partly thanks to its “devolution” arrangements for health which were in place between 2016 and 2021. At a Parliamentary committee hearing in March, it was described as the “most mature” ICS.
However, as the review notes, its performance across electives, emergency care and cancer has been an increasing concern over the last year, and NHS England recently said the system would require “mandated support” under its oversight framework.
Carnall Farrar also had some positive conclusions, including a “strong leadership commitment to improving system working” and a clear commitment within localities to reduce health inequalities.
In a letter to system leaders prefacing the executive summary of the report, integrated care board chief executive Mark Fisher wrote: “The report offers some challenging findings, but we must remember we are early in the establishment of the ICB and ICS in its new statutory footing. What the review gives us is a clear agenda for our further development.”
He said work has already started to implement the recommendations, including a more detailed delivery plan that enables progress against strategic objections as well as financial and performance requirements, and to create a “crisp and clearly articulated operating model” for the ICS.
In a statement, the ICS stressed it is one of the largest and most complex systems.
Source: Health Service Journal, 1/6/2023
