Trust ICSs and devolve funding to place

23 February 2022 Seamus Ward

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chris ham LThe report, Governing the health and care system in England: creating the conditions for success, looks at the role of the centre – NHS England, NHS Improvement, the Department of Health and Social Care, and 10 Downing Street – following the launch of ICSs, and the changes needed to improve outcomes for patients.

Written by former King’s Fund chief executive Chris Ham (pictured), it said ICS funding should be allocated on a population basis, and the systems held to account for delivering a small number of local and national priorities. The priorities should reflect ICS core purposes, including improving population health.

The paper added that ICSs must only retain resources that are agreed by all the local partners.

‘The principle of maximum devolution of funding will enable those responsible for delivering care to decide how best to use resources to improve outcomes. It will also reduce the work involved in bidding for funding and remove the "straitjacket" (to cite one regional leader) of funding tied to specific purposes,’ he said.

Performance oversight should be light touch in systems that are performing well, with rules-based interventions and support for others.

ICS leaders interviewed believed that staff numbers in the centre and regions should be slimmed down. Fewer, but more senior and experienced, staff in regions and the centre would reduce work that adds little value for frontline services, and enable more effective support to be available when required.