News / CCG board-level staff given reassurance on ICB transfer ​

31 August 2021 Steve Brown

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It was previously announced that all CCG staff below board level were being given an employment commitment – ‘lifting and shifting’ into the new organisations on the same terms and conditions. The earlier guidance did not extend this guarantee to board-level positions.PORTRAIT_news_LouisePatten

However, a new Human resources framework for developing integrated care boards, published by NHS England and NHS Improvement, has now stated: ‘It is crucial that, where possible, we retain our talented leaders and their experience and knowledge.’ The framework said there was ‘an expectation’ that board-level staff would transfer to ICBs.

The aim is to agree alternative roles and retain as many people as possible. Where this cannot be achieved, the ICB would be responsible for implementing redundancy processes.

Healthcare Finance spoke to one CCG chief finance officer (CFO), who said this was in line with the messages being delivered locally – that there was a desire to retain the skills of senior commissioning leaders. But he added that it was encouraging to see it written down.

There are currently 106 CCGs that will transition into 42 new ICBs from next April under the current timetable. This implies significant numbers of board-level officers in CCGs potentially competing for a much smaller number of similar board-level roles in new ICBs.

In reality, however, there has been a degree of streamlining across the commissioning function ahead of the changes.

‘The majority of CCGs have moved to a footprint that matches their integrated
care system (ICS),’ said NHS Clinical Commissioners chief executive Louise Patten. ‘Some have moved by merging, others by adopting a single management team or just by more aligned working.

‘Where mergers have not taken place, there is often some collaboration between finance teams across multiple CCGs. However, there may be a number of displaced CCG CFOs when ICSs appoint system finance leads.

‘There is no doubt that it will be challenging for some staff at board level,’ said Ms Patten, adding that the HR framework provided helpful reassurance over their future.

‘There are lots of opportunities and plenty of talented CCG staff, particularly in finance. They have very different skills to providers, because they oversee system finance, with one eye on the mountains in the distance rather than just the heat and light of service provision under the annual contract.

‘There will be opportunities for provider collaboratives to share a level of transparency with local authority finance – to develop a profit and loss account at place level and look at how best to use the whole budget for health and social care to best support the population.’

Ms Patten said this would position finance much more in the role of health economics and population health management.

‘There will also be lots of opportunities at the system level for senior finance leaders to take a special interest in all the primary care or specialist care commissioning that is coming,’ she continued.  ‘And there will be opportunities at supra-ICS level, where systems will have to co-ordinate services to get the scale where this makes sense.’

Interim guidance on ICB governance (see box), issued alongside the HR framework, states that a chief finance officer will be one of four executives required to be on the new boards as a minimum, working alongside a chief executive and nursing and medical directors.

While a chief executive designate should be identified by the end of November, the guidance gives ICBs until the end of quarter 4 to have selected their other executives.

However, CCG finance directors suggested the appointment process would need to happen much faster than this in reality, given the challenges of closing down in some cases multiple CCGs and establishing a completely new, more strategic organisation.

While many CCG functions will simply transfer to the ICB, there will be new processes and governance arrangements to implement, particularly around the relationship between the system and place-level working.

It is not clear exactly how finance teams will look in the new ICBs. For some activities, it is likely that numbers will need to expand. But in others – the devolution of responsibilities to place, for example – changes could reduce the numbers needed in central teams.

The timescale is tight, with a significant to-do list in continuing to monitor service provision, closing existing organisations and setting up new bodies. But system leaders are confident it can be achieved by April.


ICB governance

According to Interim guidance on the functions and governance of integrated care boards, integrated care systems exist to achieve four aims: improve outcomes; tackle inequalities; enhance value for money; and support broader social and economic development.

The new statutory ICBs are required to set out their governance and leadership arrangements in a constitution that will be formally approved by NHS England and NHS Improvement before the end of quarter 4. This can be based on a draft model constitution that has been developed centrally.

They need to plan how the ICB unitary board will be populated, with deadlines set for the appointment of chief executives (end of November) and the other principal board directors (end of Q4). They must also confirm plans to ensure commissioning functions are organised across the ICS footprint and develop a functions and decision map showing arrangements with ICS partners to support good governance.

ICBs will also need to set out the role of place-based leaders within their governance arrangements. And they must work with provider collaboratives to define their working relationship, including the participation in different committees.