Health systems

The ICB is the body legally responsible for planning how to meet the health needs of people in the Integrated Care System (ICS). ICBs manage a share of the NHS budget and arrange local health services.

ICBs look after large populations, typically 1-3 million people. Most ICBs cover several local authorities – and therefore several parent carer forums. For example, Greater Manchester ICB covers 10 local authorities, while Lincolnshire covers only one.

Children and young people are one of only two population groups specifically named in the Health and Care Act 2022 requiring specific consideration from ICBs (the other is victims of domestic violence.) This places meeting children’s health and care needs at the centre of ICB responsibilities.

ICBs and Integrated Care Partnerships (ICP) have specific legal duties towards children, including children with special educational needs and disabilities (SEND) This legal duties to children include:

• ICBs develop plans (forward plans) each financial year where they set out how they plan to meet health needs over the next five-year period.
• ICBs must consider how they will meet the needs of children and young people aged 0-25 and set this out in their forward plans.
• ICBs/ICPs must consider how to ensure a diverse skill mix on their boards. This should include a consideration of whether there is knowledge and expertise related to children and SEND.
• Each ICB must have an executive lead responsible for SEND accountable functions. This is likely, but not required to be, the Chief Nurse.
• ICBs are required to set out how they have met their statutory functions, including their SEND and Safeguarding functions, in their annual report.
• ICPs should consult children’s system leaders, children and young people, and families when forming their strategies.
• ICP strategies must explicitly consider children’s health and wellbeing outcomes.

Find your ICB.

Every ICB must appoint a board level lead for the following groups of people in their area:

• Children and young people (aged 0 to 25).
• Children and young people with special educational needs and disabilities (SEND) (aged 0 to 25).
• Safeguarding (all-age), including looked after children.
• Learning disability and autism (all-age).
• Down Syndrome (all-age).

ICBs must also appoint a lead for mental health, but they don’t have to be a Board member.

These executive lead roles are statutory under the Health and Care Act 2022 and their responsibilities include:

• Championing co-production with children, young people, and families.
• Ensuring appropriate resource allocation for children and young people’s services.
• Leading relationships with key partners across health, local authorities, social care, education, justice, and Voluntary, Community and Social Enterprises. 
• Ensuring the ICB’s joint forward plan sets out how they will meet the needs of children and young people. 
• Making sure statutory duties related to safeguarding and SEND receive appropriate focus.

Executive leads are not involved in day-to-day commissioning of services. They have board voting rights and support the Chief Executive and the Board to make sure the ICB functions effectively for these groups of people.

Often the leads for these roles are the ICB’s Chief Nurse or Chief Medical Officer. But others Board members may have this role.

NHS England (NHSE) leads the National Health Service (NHS) in England. NHSE promotes quality health and care for all through the NHS Long Term Plan. It supports NHS organisations to work in partnership to deliver better outcomes for patients and communities and provide value for taxpayers.NHS England is an executive non-departmental public body, sponsored by the Department of Health and Social Care.

NHSE has seven regional teams who support local ICSs to improve the health of the population, improve quality of care, tackle inequalities and deliver care more efficiently.

The seven regions are:

• East of England.
• London.
• Midlands.
• North East and Yorkshire.
• North West.
• South East.
• South West.

Regional teams are responsible for the quality, financial, and operational performance of all NHS organisations in their region. They also support the development of integrated care systems.

Regional parent carer forum networks will usually have good contacts with NHS regional leads for SEND. NHS England also has a SEND adviser who oversees the SEND regional leads. Contact and the National Network of Parent Carer Forums regularly meet members of the national team.

NOTE: Regional parent carer forum networks are organised according to the nine Department for Education regions that do not fully align with NHS regions.

General practitioners (GPs) treat all common medical conditions. They refer patients to hospitals and other medical services for urgent and specialist treatment.  GPs are independent contractors and work in partnerships like small businesses.

NHS England pays GPs for providing general medical services to patients, and extra quality payments agreed in the GP contract with the government.

GPs can also claim additional fees for providing Local Enhanced Services commissioned by the ICBs. Annual health checks for people with a learning disability are a ‘local enhanced service.’

Primary care networks (PCNs) are clusters of GP practices working together in their locality, collaborating with local providers across the community, social care, and voluntary sectors. They typically serve between 30,000 and 50,000 patients.

PCNs are led by clinical directors who may be a GP, general practice nurse, clinical pharmacist or other clinical profession working in general practice. Over 99% of general practices are part of a PCN, who sign up to the Network Contact DES which details their core requirements and entitlements.

You can find out more about PCNs in this video.

Integrated care systems (ICS) are partnerships of organisations that come together to plan and deliver joined-up health and care services. They were formally established under the Health and Care Act 2022.

ICS comprise:

• Integrated care board (ICB).
• Integrated care partnership (ICP).
• Primary Care Networks (PCNs – organised around GP practices).
• Provider Collaboratives.
• Place-based partnerships.
• Health and Wellbeing Boards

You can read more about ICS on the NHS England website .

The integrated care partnership (ICP) is a joint committee formed of the integrated care board (ICB) and local authorities in the integrated care system (ICS) area. It brings together the NHS and local authority leaders to better integrate health (NHS), social care (local authorities), and wellbeing services.

The ICP is a broad alliance of partners involved in improving care, health, and wellbeing of people in the ICS. Local Healthwatch is always part of the ICP.

The ICP’s main job is to produce a strategy – a type of long-term plan – on how to improve the health and wellbeing of people living in the ICS.

England has 175 place-based partnerships. These partnerships typically cover populations of around 250,000–500,000 people (although this varies widely). This is significantly smaller than the populations covered by ICSs.

While ICSs can bring the benefits of working at scale to tackling some of the major strategic issues in health and care, smaller place-based partnerships within ICSs are better suited to designing and delivering changes in services to meet the distinctive needs and characteristics of local populations.

Place-based partnerships typically involve the NHS, local government and other local organisations. Their responsibilities include planning and delivering services, such as voluntary, community, Faith and social enterprise (VCFSE) sector organisations and social care providers. They may also work alongside other community partners with an influence on health and wellbeing. This includes schools, emergency services and housing associations. They may work with people who use services.

Individual parent carer forums who are part of an ICB that covers many PCF areas may focus on influencing and co-production activity at ‘place-based partnership’ level rather than with the ICB. It is worth remembering that while the ICB delegates health funding to ‘place-based partnerships’, accountability – and ultimate decision-making on health services– sits with the ICB.

Provider collaboratives bring together two or more NHS trusts (public providers of NHS services including hospitals and mental health services) to work together at a big scale to benefit their populations.

All hospitals and trusts need to be a member of a provider collaborative. They usually cover several ICBs. For example, the South London Partnership covers three. They were set up to encourage greater collaboration and reduce competition between hospital trusts.

The most ‘mature’ collaboratives are for children’s mental health services and autism and learning disability services. Collaboratives get funding delegated from ICBs. Many provider collaboratives have their own commissioners.

Find provider collaboratives in your area