Key Facts

• The clause confers a power to provide assistance and support to NHS foundation trusts and other health service providers in England.
• Clause 6 replaces the functions of the NHS Trust Development Authority and existing powers of NHS England to support clinical commissioning groups and primary care providers.
• Proposed new subsection (3) allows for financial assistance provision to integrated care boards.
• Clause 7 enables NHS England to direct ICBs to exercise certain functions.
• Subsection 13YB(4) is mentioned as a point of inquiry for potential prohibitions on delegation from ICBs.
• MP Justin Madders raises a query about proposed new section 65Z4(4) under Clause 8.
• The clause gives the Secretary of State power to direct trusts to provide reports or information deemed necessary.
• Edward Argar responds that these powers are pragmatic and necessary for obtaining further clarifications from individual trusts as needed.
• Clause 10 removes powers regarding quality payments from the Secretary of State.
• Quality payments will continue but be made to integrated care boards instead of CCGs.
• Clause 37 provides broader power for directing NHS England on quality payments.
• The clause establishes ICBs as the primary commissioners for health services in England.
• ICBs will take over the commissioning responsibilities currently held by CCGs and some that are commissioned by NHS England, such as primary care, dentistry, pharmacy, and optometry services.
• Subsections (2) and (3) of proposed new section 14Z26 allow CCGs to determine their own processes for consulting on ICBs.
• The amendment seeks to insert “NHS trust, NHS foundation trust, trade union, patient representatives and local authority” after “board” in clause 13.
• There are currently 42 ICS areas defined in the Bill.
• Local authorities should be involved in setting ICS boundaries as they already integrate multiple public services around a defined population.
• The Cheshire and Merseyside ICS covers 2.6 million people.
• It incorporates 9 CCGs in Cheshire alone, moving from four to one as recently as April 2020.
• There are 19 NHS provider trusts and 51 primary care groups involved.
• The current arrangements will be reviewed for two years starting from the boundary review of ICSs.
• The current funding model often prevents healthcare organizations from addressing population health effectively.
• CCGs are rebranded as large entities without real discretion over spending.
• CCGs control over £75 billion of taxpayers' money.
• The proposed ICSs need to attract and retain high-quality management for impact.
• NHS England is required under clause 13 to consult affected ICBs before varying or revoking their establishment order.
• The amendment seeks to add an additional requirement for NHS England to consult relevant trusts, unions, patient representatives and local authorities.
• Exceptions to the presumption of coterminosity were made in high-performing areas like the east of England and Frimley.
• The Cheshire and Merseyside ICS may not survive two years.
• STPs (Sustainability and Transformation Plans) were put together with a short timeframe around Christmas 2017 or 2016.
• There is frustration over the lack of clarity on why certain decisions were made for these areas.
• Merseyside has a metro Mayor with clearly defined geography.
• Cheshire is considered a different area from Merseyside.
• Proposed new sections 14Z25 and 26 address duties to consult members of the ICB.
• Amendment 10 amends proposed new section 14Z28 to widen NHS England's power for transfer schemes when establishing ICBs.
• Amendment 38 aims to enhance accountability for integrated care boards (ICBs).
• Each year, ICBs must prepare and publish reports on their performance.
• A Minister of the Crown must make a motion in the House of Commons regarding the report within one month.
• The amendment would place new requirements on ICBs to report annually directly to the Secretary of State.
• NHS England will undertake annual performance assessments of each ICB, which must be published.
• The Bill already includes comprehensive reporting requirements and accountability measures for ICBs.
• The amendment aims to ensure proper consultation processes are in place for policy changes within ICB areas.
• There has been a reduction in the number of clinical commissioning groups (CCGs) in Cheshire and Merseyside.
• Variations exist in CCG policies, such as rules on gluten-free products available on prescription and IVF treatment cycles.
• Amendment 31 proposes an initial chair appointment period of no more than 2 years.
• Subsequent chairs would be elected by voters in their area.
• Amendments 50, 51, and 52 are related to ensuring consultation with ICB members before appointments.
• Amendment 31 aims to establish an elected chair for ICBs.
• Amendments 50, 51, and 52 address concerns about the appointment and removal of ICB chairs.
• The NHS document on the ICS design framework was released in July.
• Many ICB chairs have already been appointed disregarding parliamentary scrutiny.
• The NHS budget is expected to account for up to 40% of general government spend in the next few years.
• Amendments aim to establish an elected chair for ICBs within two years, allowing time for organisations to get established.
• NHS England and various local bodies need clear alignment on roles and responsibilities.
• The chair of an ICB is appointed by NHS England with approval from the Secretary of State.
• The ICB carries national statutory responsibility and is accountable to Parliament through NHS England.
• The chief executive, Amanda Pritchard, stated that ICBs are accountable to a combined NHS England and NHS Improvement structure.
• Dual accountability for spending NHS money is not approved by the NHS.
• Amendments 31, 50, 51, and 52 were tabled by the shadow Minister.
• The NHS accounts for about 40% of Government expenditure.
• The proposal would split the NHS into 42 areas.
• Amendment 31 was voted on but not passed with Ayes 4 and Noes 9.
• Amendment 50 was also proposed but rejected.
• The amendment aims to add five new members to the current minimum composition of integrated care boards.
• NHS England has sole authority over choosing and removing the chair of an integrated care board.
• Paragraphs 3 to 7 of schedule 2 outline the existing minimum membership requirements for integrated care boards.
• Dame Gill Morgan has set up an ICS.
• Mental health and social care are integrated around the table in her ICS due to practical necessity, not just directive.
• The MP uses a football analogy to caution against having too many people involved, which could make the system unworkable.
• The amendment supports representation from mental health backgrounds.
• Director of Public Health (DPH) should be part of the ICB as they bring unique cross-system relationships and local insight.
• A designated social care representative is needed to explicitly represent social care in fostering collaboration.
• Staff voice through recognised trade unions should be included on ICBs.
• Patient voice representation is crucial for decision-making legitimacy.
• Schedule 2 sets out minimum membership requirements for integrated care boards (ICBs).
• ICBs should include members nominated by trusts, foundation trusts, primary medical service providers in the area, and local authorities.
• The amendment aims to ensure inclusion of voices representing mental health, public health, social care workforce, and patients on ICBs.
• The amendment proposes a more prescriptive approach to ICB membership compared to the current legislative minimum.
• Schedule 2 allows the Secretary of State to add further requirements via regulation-making powers at a later time.
• The Minister emphasizes the need for local flexibility and effective board sizes, citing evidence from Martin Marshall.
• Nearly 70% of practices operate under GMS contracts.
• Another quarter operates on PMS models, which are being phased out.
• APMS is a flexible contracting model allowing for private companies to take over practices.
• The latest GP survey found that 89%, 88%, and 93% of patients rated their healthcare experience positively.
• Spending on private sector before the pandemic was £9.7 billion.
• Figures cited pre-pandemic are double what they were a decade earlier under Labour Government.
• Dr Chaand Nagpaul testified to the value of NHS accountability and loyalty.
• Public Health England had £400 million compared to billions for Test and Trace, with local teams reaching 97% contacts vs. 60%.
• Integrated care boards (ICBs) will consist of members appointed by NHS providers, providers of GP services, and local authorities.
• The government proposes a Government amendment on Report to prevent individuals with significant interests in private healthcare from sitting on ICBs.
• Independent providers include social enterprises and partnerships providing services to homeless people and asylum seekers.
• Amendment 33 to schedule 2 has been debated.
• The speaker decides not to move the amendment formally due to concessions made by the Minister.