Governance handbook FAQs

Yes, the ICB has inherited the commissioning functions and responsibilities of the former Clinical Commissioning Groups (CCGs) in the North East and North Cumbria, and these are set out in detail in sections 3 and 3A of the 2006 NHS Act. These include:

• Arranging for the provision of the following to such extent as it considers necessary to meet the reasonable requirements of the persons for whom it has responsibility:
• hospital accommodation,
• other accommodation for the purpose of any service provided under the 2006 Act,
• medical, dental, ophthalmic, nursing and ambulance services,
• such other services or facilities for the care of pregnant women, women who are breastfeeding and young children 
• such other services or facilities for the prevention of illness, the care of persons suffering from illness and the after-care of persons who have suffered from illness 
• such other services or facilities as are required for the diagnosis and treatment of illness.

In inheriting these functions, the ICB now has responsibility for the following:

• persons who are provided with primary medical services by a registered GP practice in the ICS area, and
• persons who usually reside in the ICS area and are not provided with primary medical services by a registered GP practice in the ICS area
• persons who were provided with primary medical services by a person who is or was a member of a registered GP practice in the ICS Area
• persons who have a prescribed connection with the ICS area (e.g. the provision of services or facilities for emergency care for every person present in the ICS area).

In exercising its functions under section 3 and section 3A of the 2006 NHS Act, the ICB must act consistently with:

• the discharge by the Secretary of State and NHS England of their duty under section 1(1) ('duty to promote a comprehensive health service') of the 2006 NHS Act, and
• the objectives and requirements for the time being specified in the NHS mandate published under section 13A of the 2006 NHS Act.

Furthermore, under Section 3A of the 2006 NHS Act, the ICB now assumes the responsibilities previously held by the CCGs to arrange for the provision of such services or facilities as it considers appropriate for the purposes of the health service that relate to securing improvement - 

• in the physical and mental health of the persons for whom it has responsibility, or
• in the prevention, diagnosis and treatment of illness in those persons.

Although the NHS is nationally accountable through its mandate from Parliament and Government, we must also work closely with all the local authorities in our area who are accountable to local politicians and residents.

As such, the composition of our ICB was jointly developed and agreed with our partners, including local authorities. This included four 'partner member' seats at our ICB for local authorities comprising one elected member and three senior local authority officers from the professional disciplines of adults' social care, children's social care and public health.  National guidance is clear that these ICB partner members are there to bring a perspective from their respective sectors, but not to act as a delegate of their sector or organisation.

However, elected members and senior officers from every single local authority in the Integrated Care System (ICS) area will also serve on the Integrated Care Partnership (ICP) – this is the body that sits alongside the ICB as the key governance body of the ICS. It is formed as a statutory committee of the ICB and the thirteen local authorities in the ICS area and its key responsibility will be to agree the strategic priorities for the ICS through an Integrated Care Strategy.  Alongside this, elected members will continue to lead and serve on Health and Wellbeing Boards which will set the strategic priorities for health and care in each local authority area, and they will also continue to scrutinise the performance of the ICB through local and sub-regional sub-committees.

The board also includes a representative from our ICS Healthwatch network to ensure the needs, experiences and concerns of people who use health and social care services and to speak out on their behalf. And our local Healthwatch organisations will continue to play a key role representing the views of service users in each of the local authority areas in our ICS area.

We have included several clauses in our constitution relating to private sector representation on our ICB which you can view here.

Disqualification Criteria for Board Membership are set out under Clause 3.2, and include 'a person whose appointment as a Board member is considered by the person making the appointment as one which could reasonably be regarded as undermining the independence of the health service because of the candidate’s involvement with the private healthcare sector or otherwise’. All members of committees and sub-committees that exercise the ICB commissioning functions will be approved by the Chair.

Furthermore, the ICB Chair will not approve an individual to such a committee or sub-committee if they consider that the appointment could reasonably be regarded as undermining the independence of the health service because of the candidate’s involvement with the private healthcare sector or otherwise; as well as at Clause 6.1.1 'As required by section 14Z30 of the 2006 Act, the ICB has made arrangements to manage any actual and potential conflicts of interest to ensure that decisions made by the ICB will be taken and seen to be taken without being unduly influenced by external or private interest and do not, (and do not risk appearing to) affect the integrity of the ICB’s decision-making processes.'

 Transparency and accountability are guiding principles of the ICB and we are required by law to ensure that its meetings are accessible and held in public, and we will also broadcast its meetings live and allow access to a recording of the meeting on this website. Alongside this, all of the ICB's papers are published in advance on the public, and we welcome questions from the public in advance of the meeting via the website.

In addition to this, section 9.1.1 of our ICB Constitution dealing with Arrangements for Public Involvement (in line with section 14Z45(2) of the 2006 NHS Act) sets out how we will ensure how individuals to whom services which are, or are to be, provided pursuant to arrangements made by the ICB in the exercise of its functions, and their carers’ and representatives, are involved (whether by being consulted or provided with information or in other ways) in:

• the planning of the commissioning arrangements by the ICB
• the development and consideration of proposals by the ICB for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals (at the point when the service is received by them), or the range of health services available to them, and
• decisions of the ICB affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact.

Furthermore, under section 9.1.2 (and in line with section 14Z54 of the 2006 Act) the ICB has made the following arrangements to consult its population on its system plan:

• The ICB will engage or consult, as appropriate, with its population on its system plan and will have regard to NHS Guidance on consultation and engagement and the ICB's Communities and People Involvement and Engagement Strategy for the North East and North Cumbria. This will include the involvement of each relevant Health and Wellbeing Board.
• In addition, the ICB has adopted the ten principles set out by NHS England for working with people and communities.
• Put the voices of people and communities at the centre of decision-making and governance, at every level of the ICS.
• Start engagement early when developing plans and feed back to people and communities how it has influenced activities and decisions.
• Understand your community’s needs, experience and aspirations for health and care, using engagement to find out if change is having the desired effect.
• Reach out to and build relationships with excluded groups – especially those affected by inequalities.
• Work with Healthwatch and the voluntary, community and social enterprise sector as key partners.
• Provide clear and accessible public information about vision, plans and progress to build understanding and trust.
• Use community development approaches that empower people and communities, making connections to social action.
• Use co-production, insight and engagement to achieve accountable health and care services.
• Co-produce and redesign services and tackle system priorities in partnership with people and communities.
• Learn from what works and build on the assets of all partners in the ICS – networks, relationships, activity in local places.

These principles will be used when developing and maintaining arrangements for engaging with people and communities which include:

• The Communities and People Involvement and Engagement Strategy for the North East and North Cumbria.
• Ensuring sufficient resources and training are available to support effective engagement
• Arranging system-wide or place-based public events
• Appointment of a Non-Executive Member with a specific role to seek assurance on the ICB's arrangements for discharging its duties in relation to patient and public involvement.

As an ICB we adhere to the national 'Agenda for Change' (AfC) pay framework for all of our staff which harmonises their pay scales and career progression arrangements across traditionally separate pay groups.

This is something that all NHS providers plan for in managing the discharge of patients back into the community, working closely with local authorities. We recognise the challenges of ensuring that appropriate packages of social care support are always available and in place to support discharge and this is something that we are focusing on through our place-based working arrangements with local authorities, as well as initiatives to increase the supply of high-quality social care provision and sharing and spreading best practice across our ICS area.

The government is committed to giving patients greater choice and control over how they receive their healthcare, and to empowering patients to shape and manage their own health and care.

When CCGs were replaced by ICBs, NHS England assumed the responsibility for the oversight of existing patient choice requirements – and although in the vast majority of cases patient choice is exercised by choosing between NHS providers, patient choice also includes access to some private hospitals for treatment as long as this is at no greater cost to the NHS. (This is in addition to the provision of primary care, which is, in most cases, independent businesses whose services are contracted by NHS commissioners to provide generalist medical services in a geographical or population area.)

It is intended that the patient choice provisions in the 'National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012' will be amended, and new guidance will be issued shortly. In the interim, existing choice regulations will continue to have effect.

Currently, when awarding contracts for healthcare services, NHS England and ICBs are required to comply with both the NHS (Procurement, Patient Choice and Competition) (No.2) Regulations 2013 and, where the contract is valued at £663,540 or above, the Public Contracts Regulations 2015. Until a new NHS Provider Selection Regime is put onto statutory footing, the Current NHS Procurement Regime applies.

The NHS Provider Selection Regime (PSR) will be a new set of rules for arranging healthcare services in England. This aims to give decision-makers such as ICBs a more flexible process for deciding who should provide healthcare services, to make it easier to integrate services and enhance collaboration, and to remove the bureaucracy and cost associated with the current rules.

The PSR is intended to fit with the integrated, collaborative approach to healthcare commissioning being established in the 2022 Health and Care Act by providing a decision-making process that makes space for collaboration to happen and that ensures all decisions about how healthcare is arranged are made transparently and fairly, and in the best interests of patients, taxpayers, and the population. This new regime is not expected to be in use in time for the 2023/2024 NHS contracting round, but we expect more clarity on timeframes for implementation from Government to be published shortly.