Integrated care strategy, health and wellbeing board and joint forward plan guidance: what you need to know

Background

From 1 July 2022, all 42 integrated care systems (ICSs) across the country became legal entities, with statutory responsibilities to deliver for their local populations. Legally, ICSs comprise two core parts: an integrated care board (ICB), the budget-holding body, and an integrated care partnership (ICP), a broader coalition of partners within the system, to join up planning and delivery.

The ICP will be required to produce an integrated care strategy to set the strategic direction for health and care services across the whole geographic area of the ICS, including how commissioners in the NHS and local authorities can deliver more joined-up, preventative, and person-centred care for their local population. The ICB and its partner trusts have a duty to prepare a joint forward plan (JFP), to set out how they will arrange and/or provide NHS services to meet their populations physical and mental health needs. Systems are encouraged to use the JFP to develop a shared delivery plan for the integrated care strategy and joint local health and wellbeing strategy (JLHWS), that is supported by all partners across the system.  

In this context, the Department of Health and Social Care (DHSC) has produced guidance on integrated care strategy development, health and wellbeing boards (HWBs) and partnership working. NHS England (NHSE) has produced guidance on developing the joint forward plan. To help members digest the guidance, this briefing serves as a summary of each.

Summary of the guidance 

1. Integrated care strategy guidance

The guidance is broadly structured into four sections: an introduction to the strategy and its purpose; processes for producing the strategy; its content; and the publication and review of the strategy.

• The government outlined its expectation that the integrated care strategy will be informed by the HWBs' Joint Strategic Needs Assessments (JSNA). ICPs should use these assessments, but also carry out further research and draw on other data sources, to build a holistic understanding of their local populations’ health and care needs.
• Integrated care strategies are encouraged to focus on activity that can be delivered by systems at system (or cross-system) level, while Joint Local Health and Wellbeing Strategies (JLHWSs) – developed by HWBs – should focus on what can be delivered at ‘place’ and in communities. In the few systems where ICPs and HWBs are coterminous, the government recommends that they work with partners to agree what sits within the scope of the integrated care strategy and what sits within the JLHWS.
• ICPs and HWBs have statutory commitments to deliver both of their strategies separately; however, they should be aligned.
• ICPs should engage with local Healthwatch organisations; local people and communities; providers of health and social care services; the voluntary, community, and social enterprise (VCSE) sector; local authority and ICB leaders; and wider organisations and partnerships to ensure a wide range of people are able to engage and input into the production of the strategy. 
• The guidance includes a full list of people and organisations to consider engaging (see Annex A), but this is intended as a non-exhaustive list and there is not an expectation that all stakeholders must necessarily be consulted. There may be stakeholders not listed who are appropriate and important to speak to.
• The government has recognised that the contents of the strategy will vary from system to system but expects agreeing shared outcomes within the ICS, quality improvement, and joint working under section 75 of the NHS Act 2006, to be important aspects of all strategies. 
• The guidance outlines some key areas to consider when producing the strategy, including: personalised care; addressing disparities in health and social care; population health and prevention; health protection; babies, children, young people and their families, and healthy ageing; workforce; research and innovation; health-related services; and data and information sharing. 
• ICPs will need to consider revising their strategy when they receive a new JSNA, and are encouraged to work with HWBs, local authorities and ICBs to align the timelines of their strategies with the five-year joint forward plan.

​​​​​2. Health and wellbeing board guidance

• The guidance on HWBs had not been updated since 2013 and this document aims to bring the guidance up to date in line with the establishment of ICSs. It contains a selection of case studies to demonstrate how system partners are working together under the new ICS arrangements.
• The publication focuses on the role of HWBs in enabling effective system and place-based working and provides clarification about their role within systems. It accompanies previously published statutory guidance on JSNAs and JLHWSs.

• HWBs and ICPs are expected to work collaboratively in the preparation of the integrated care strategy to tackle challenges that are best dealt with at a system level. When the HWB receives an integrated care strategy from the ICP, it does not need to refresh the JLHWS if it considers it to be sufficient. The integrated care strategy should bring learning from across the system to drive improvement and innovation.
• ICBs and their partner trusts are required to share their joint capital resource use plan and any revisions with each relevant HWB. This is a new duty on an ICB not previously required of a CCG.
• In areas where the ICP and HWB are coterminous, it may be appropriate for the HWB and ICP to have the same members. For ICPs where there is just one HWB in their area, it is up to the HWB and ICP to determine how their two strategies complement each other and ensure that the assessed needs are addressed between them.

3. Principles for adult social care sector engagement with ICPs

• The guidance sets out a series of four engagement principles for ICPs and adult social care (ASC) providers to guide their work together. It serves to ensure ASC providers are involved as essential partners within the ICP and therefore the development of the integrated care strategy.

4. Principles for health oversight and scrutiny committee engagement with ICPs

• The guidance sets out expectations for how ICBs, ICPs, local authority health overview and scrutiny committees (HOSCs) and other local system partners will work together to ensure that systems are locally accountable to their communities.

 5. Guidance on developing the joint forward plan

• ​​​​​​The guidance has been developed by NHSE to support ICBs and their partner trusts to develop their first five-year joint forward plans (JFPs) with system partners. It sets out a flexible framework for JFPs to build on existing system strategies and plans, in line with the principles of subsidiarity.
• Systems have significant flexibility to determine their JFP’s scope as well as how it is developed and structured. At a minimum, it should describe how the ICB and its partner trusts intend to arrange and/or provide NHS services to meet their population’s needs.
• The guidance includes a summary of legislative requirements that the JFP must meet (see appendix 2). It also shows the statutory framework relating to the JFP and its relationship with other strategies and plans (see appendix 1).
• ICBs and their partner trusts must involve relevant HWBs in preparing or revising the JFP. They must share a draft with each relevant HWB and consult on whether the JFP takes proper account of each JLHWS.
• The three principles describing the JFP’s nature and function are:
  • Fully aligned with the wider system partnership’s ambitions.
  • Supporting subsidiarity by building on existing local strategies and plans as well as reflecting the universal NHS commitments.
  • Delivery focused, including specific objectives, trajectories and milestones as appropriate.
• ICBs have a statutory duty to have regard to the integrated care strategy, JLHWSs and JSNAs when exercising any relevant functions, and will address objectives in the government mandate regarding the ambitions in the NHS Long Term Plan and NHS planning guidance.
• ICBs will be expected to work with their ICPs; primary care partners; local authorities; the voluntary, community and social enterprise sector; NHS collaboratives, networks and alliances; and people and communities in the development of the JFP.  
• NHS England will review and comment on draft JFPs and expect ICBs and their partner trusts to produce a first draft for consultation by 31 March 2023, with a view to publishing a final version by 30 June.  
• ICBs and their partner trusts must review the JFP and either update or confirm it annually before the start of each financial year – i.e. 1 April. ICBs will also be required to prepare a capital plan – setting out their planned capital resource use – by this time.
• ICBs and their partner trusts will continue to separately submit specific operational and financial information as part of nationally coordinated NHS planning.

Viewpoint  

The five documents outline clear guidance and recommendations for producing the integrated care strategy and joint forward plan, and how partners in the system can work together to improve population health and wellbeing. We welcome the permissive approach the government and NHSE have taken, and the useful case studies which members can draw upon to understand what is happening across the country. It also helps to reiterate the crucial role that these broad partnerships can play in planning and delivering health and care across their geographies and putting their strategies at the heart of integrated care systems.

We are pleased to see that the guidance and engagement principles clarify how ICPs, ICBs, local authorities and other system partners will work together and the need for collaborative working to truly understand local populations’ needs. It is also reassuring to see that NHSE has given ICBs significant flexibility to decide how they develop their JFPs. Local autonomy is something we and our members have consistently called for as it will be critical to the success of system working and meeting the needs of local populations.

The guidance rightly acknowledges the transitional period ICSs are in, however, leaders have expressed concerns about the timeframes set for the strategy development and how much detail they have been able to include. Leaders recognise that this is an iterative process from which to build on with system partners but have asked whether there is value in that if the exercise cannot be completed to a comprehensive degree.

Our members felt that the ambition ICSs will demonstrate in these strategies must also recognise the reality and the pressures health and care organisations are currently facing. The rising cost of living is continuing and will continue to have a profound impact on people’s physical and mental health, exacerbating health inequalities and increasing demand for services. Measures to address these challenges do not rest solely with the health and care system.      

We look forward to working with members as they take forward their integrated care strategies and joint forward plans over the coming months. We will continue to relay leaders’ views, challenges and experiences to help inform the review in summer 2023 into integrated care strategy guidance. Our partnership with the Local Government Association to deliver a forum for ICP chairs to connect and address some of these challenges is just one way in which we are working directly on these issues.                                   

Key actions for members

Several expectations are set out for members throughout the publications. These include:

How we are supporting members

Following the requirement for ICPs to produce integrated care strategies in early 2023, we have been working with NHS England, DHSC and the LGA to analyse the mostly draft or interim strategies published by systems. Our analysis (below) provides an overview of the themes emerging from the first iterations of these strategies.

We will continue to support ICS leaders to share, learn and engage with one another through our member forums and support programmes. Our feedback sessions with DHSC ensured members views were reflected in the guidance and provided an opportunity for leaders to ask questions. It also identified some questions around the role of the Care Quality Commission and system regulation in the context of integrated care strategies – we are exploring how we can support members with this.

DHSC will be issuing statutory guidance on the new call-in powers of the Secretary of State and will outline how they propose to exercise their functions under the new reconfigurations process. The guidance will include information for NHS commissioning bodies, NHS trusts and NHS foundation trusts about how they should be exercising their functions under the new process. We will work with system leaders to share their insights and expertise with DHSC in the development of the guidance.

Further information

If you have any questions about the guidance or are interested in the forums we are hosting, please contact Ian Perrin, senior policy adviser, ICS Network.