Integrated care systems

The intention of the Health and Care Act 2022 is to establish a legislative framework, making it easier for health and care organisations to deliver joined-up care for people relying on multiple services. Inadequacies in the previous system, established under the Health and Social Care Act 2012, were highlighted during the COVID-19 pandemic. 

Provisions in the 2022 Act will come into force at different times and secondary legislation will flow from the 2022 Act.  

One of the key changes brought about by the Act include the creation of integrated care systems (ICSs).  

ICSs are regarded as the future of health and care integration in England. They are partnerships between organisations that meet health and care needs across a geographical area, working to co-ordinate services and plan ways to improve population health.  

ICS regions 

In July 2022, 42 ICSs were established on a statutory basis, covering every region in England. The regions are listed in a systems directory on the NHS England website. 

ICSs serve local populations of between 600,000 and 1 million people. They will replace the now-dissolved 106 NHS Clinical Commissioning Croups (CCGs) which existed as an informal and alliance-based arrangement. ICSs now take on legal responsibility for NHS resources and the commissioning of services locally. 

ICS responsibilities 

ICSs exist to: 

• Improve the health of all residents. 

• Better support people living with multiple and long-term conditions. 

• Prevent illness. 

• Tackle variation in care. 

• Deliver seamless services. 

ICSs aim to create a joined-up approach across local councils, the NHS, and strategic partners such as the voluntary, community and social enterprise sectors. They remove traditional divisions between hospitals and general practitioners, between physical and mental health, and between NHS and council services.  

Each component is required to have three ‘partner members’ from an NHS trust, general practice, and a council.  

Along with partner organisations, ICSs must prepare a five-year forward plan to meet the local population’s health needs, with the aim to financially break even each year.   

The Care Quality Commission will oversee and assess ICSs, along with council adult social care duties. 

ICSs have two statutory components:  

1. Integrated care boards (ICBs) 

Responsible for the commissioning and oversight of most NHS services, including ambulances, primary care, mental healthcare, hospital (acute), community and specialist care, and are accountable to NHS England for NHS spending and performance.  

2. Integrated care partnerships (ICPs) 

Statutory joint committees with a broader focus bringing together organisations from across the system to develop an integrated care strategy to address the health, social care and public health needs.  

Risk and insurance implications 

Prior to the creation of ICBs and ICPs as legal entities, the insurance exposures were generally covered under their partner organisation’s insurance programmes. For example, NHS foundation trusts covering clinical risks and councils covering social care exposures (where applicable).   

Careful consideration and discussions between the ICS, their partner organisations (and insurance advisors) are required to ensure all risk insurance exposures are considered and adequately covered under the new health and care system.  

NHS Resolution has confirmed the Clinical Negligence Scheme for Trusts will extend to cover clinical negligence claims brought against ICBs. The Liability to Third Parties Scheme and Property Expenses Scheme will also extend to cover the ICBs against non-clinical claims, including provisions for legacy claims arising from the previous CCGs. 

Due to the intended limitations in the NHS Resolution risk pooling schemes coverage, a risk profiling exercise is recommended to establish any potential coverage gaps. For example, it is uncertain if any property assets will transfer to the ICSs. 

The council and NHS trust insurance programmes will also require review to determine their adequacy. For example, will a council’s officials indemnity policy extend to cover a director if they sit on an external board (an ICB). If any exposures are identified, the various parties will need to consider if any additional insurance coverage is required and if so, should the insurance policies be ring-fenced under a standalone insurance programme in the name of the ICS. 

As a leading supporter of both councils and NHS trusts, Gallagher is well-placed to support discussions around insurance exposures for ICSs.