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Health and Care Bill 2021: The role of local authorities in Integrated Care Systems

In the latest in a series of comment pieces on the Health and Care Bill 2021, Anna Hart, Charlotte Burnett and Hamza Drabu consider how local authorities and combined authorities will engage with Integrated Care Partnerships and Integrated Care Boards.

New spaces and mechanisms for collaboration

The Bill introduces a number of new means by which local authorities will collaborate with the NHS:

Integrated Care Partnerships (ICPs): These will operate as joint committees between Integrated Care Boards and the local authorities on their patch. Those organisations will form their core membership, but it will be open to them to invite other stakeholders to join the committee. Given that a wide range of stakeholders are understandably vying for a seat at the table at system level, membership of the ICP may be a viable option. In our view this is preferable to having an overly large ICB membership that may undermine its agility and effectiveness. The core purpose of an ICP will be to publish an Integrated Care Strategy which describes how needs for health and care services within the area are to be met by the ICB, NHS England and local authorities. Those organisations in turn are required to have regard to the strategy, which will therefore be pivotal to determining the priorities within the Integrated Care System.

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Alongside providing for ICPs, the Bill maintains current arrangements for Health & Wellbeing Boards (HWBs) but does not define the relationship between ICPs and HWBs. This will be for local determination, but it seems likely that HWBs will do for “place” what ICPs do at system level – engaging a wide range of stakeholders and ensuring their voice is heard in determining priorities and overseeing progress.

Local authority nominated members on ICBs: Each ICB is required to have a member jointly appointed by the local authorities whose areas fall within the footprint of the ICB. The process for identifying this individual has not been prescribed and may be complex, particularly where local authorities within the same ICS have differing political balance and priorities for their local areas. The role of these individuals will not be to lobby for the interests of authorities, but rather to bring a local authority perspective - touching on areas such as social care and the wider determinants of health - to the planning and delivery of health services.

More new joint committees between NHS bodies and local authorities: In addition to ICPs, the Bill provides for the establishment of further joint committees between local authorities and NHS bodies, including both commissioners and providers. While local authorities can establish such committees, they are unable to exercise their own functions through this form of committee - so there will be a continuing role for partnership based on s.75 arrangements. The role of the local authority will again be to bring social care and public health perspectives to the work of the NHS. The use of such committees will support a number of the models for “place” described in recent guidance from the Local Government Association and NHS England.

With so many points of contact between local authorities and the NHS, local authorities will need to keep under review how they balance the roles of promoting and implementing the local health and care agenda while at the same time providing democratic oversight and scrutiny on behalf of their local populations.

Leading on the wider determinants of health

It is generally recognised that the optimal use of public resources is to focus on keeping people well and addressing the factors that impact on their health, rather than providing care and treatment when they have become unwell. It’s also understood that only around 20% of the health inequalities that people experience are attributable to their access to and outcomes from receiving health services. The Bill requires the NHS to take into account how its decisions affect the health and wellbeing of the community, but NHS bodies are not given any new statutory duties or powers to commission or provide services that address the wider determinants of health. Local authorities must therefore be at the front and centre of efforts to address the wider determinants of health. Local authorities are also stewards of the data and public health expertise that will inform how best to target the wider determinants of health, as well as supporting the design and delivery of health services.

The great unknown

The last few days have seen speculation in the press that we are about to see a White Paper proposing the establishment of a “National Care Service”. What this might mean for the existing social care responsibilities of local authorities remains to be seen.  It must also be a possibility that the existing Bill will be amended to lay the groundwork for these proposals, or that some of the new arrangements for local authority involvement in health and care will quickly be revised once they have been implemented.  We will of course keep you up to date on developments and provide our analysis as and when the proposals emerge.

Whatever happens, it will be increasingly important for the NHS to understand how local government works in order to best collaborate.

We are well placed to assist with these issues, with our teams combining health and social care expertise, including a number of lawyers who have previously worked in local authorities.

Anna Hart, Charlotte Burnett and Hamza Drabu are partners at DAC Beachcroft.

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