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Integrated Care Systems

Volume 699: debated on Thursday 22 July 2021

Earlier this year, Ministers asked NHS England to set out options for boundary alignment in integrated care systems in specific geographies where upper-tier local authorities currently have to work across more than one ICS footprint and to assess the impact of changes to deliver alignment in each case. Over the last six months NHS England has worked with stakeholders to develop advice and analysis for each of the affected areas to inform the final decision.

This work has now concluded, with advice provided to the Secretary of State for Health and Social Care. This statement sets out the final decision that has been taken for the areas in scope of the review:

East of England




West Birmingham

North Northamptonshire

This work has been underpinned by the principle that coterminous boundaries deliver clear benefits in integration between local authorities and NHS organisations. As approaches to integrated care develop it is crucial that we have a system that helps support closer working both across NHS organisations and between the NHS and local government.

On the ground, coterminous boundaries can also improve joined-up decision making on delivery of services for patients. Improved alignment can allow areas to build joint care models around a wide variety of services including children’s and adult social care services, public health, as well as community and mental health services which are often also aligned along local authority footprints.

There has therefore been a strong presumption of moving towards coterminosity, save for in exceptional circumstances where there were strong reasons for not doing so.

NHS England regional teams have conducted robust engagement activity with local stakeholder organisations to develop analysis of the risks, mitigations and benefits for any options for coterminous boundaries in the affected areas. This engagement has included roundtables with local NHS organisations, including the ICS’s themselves as well as providers, commissioners and local authorities.

The Department of Health and Social Care has engaged at ministerial level with parliamentarians as well as national organisations such as NHS Providers and the Local Government Association to ensure their views were reflected in the final advice to the Secretary of State and they had an opportunity to feed into the development of this work.

The Secretary of State for Health and Social Care’s decision process has involved careful consideration of a wide range of issues, perspectives and interests and a careful weighing up of risks and benefits, outlined in the analysis provided by NHS England for each area as well as having regard to his legal duties.

These have been considered on an case-by-case basis for each area and where NHS England has made a recommendation based on broad (not universal) local consensus, including a recommendation to retain the status quo, the Secretary of State has listened and has accepted these recommendations. There was not a broad local consensus for three of the areas within this review and as such no recommendations were made by NHS England. In these areas a balanced judgement was taken, weighing up the risks and benefits of a change in boundaries and having regard to his legal duties by the Secretary of State.

Following this review, the Secretary of State has concluded:

East of England—this area is considered an appropriate exemption to the principle of coterminosity. No changes will be made to the existing boundaries.

Frimley—this area is considered an appropriate exemption from the principle of coterminosity. No changes will be made to existing boundaries.

Glossop—The decision has been taken to move the area of Glossop from Greater Manchester ICS into Derbyshire ICS.

Bassetlaw—The decision has been taken to move the area of Bassetlaw from South Yorkshire and Bassetlaw ICS into Nottingham and Nottinghamshire ICS thus delivering coterminous boundaries for the area.

West Birmingham—The decision has been taken to move west Birmingham from the Black Country and West Birmingham ICS into Birmingham and Solihull ICS thus delivering coterminous boundaries for the area.

North Northamptonshire—The decision has been taken to move the Lakeside Healthcare GP practice into Northamptonshire ICS and retain the Wansford and Kings Cliffe GP practice in Cambridgeshire and Peterborough ICS. This moves the region much closer to coterminous boundaries and reflects specific local considerations.

Local areas may still wish to keep under review how their boundaries are working in the light of any new legislative framework. Therefore, this decision does not preclude the important work many systems undertake naturally to ensure they have a system and boundaries that best suit local needs. We have already heard such requests from local stakeholders around Cheshire and Merseyside ICS, as such the Secretary of State has also announced his intention to review this system. The Secretary of State also intends to review the areas of Cumbria and North Yorkshire, as we are now aware, they will remain non-coterminous following the conclusion of the Ministry of Housing, Communities and Local Government’s unitarisation process. These reviews will take place in two years, following the implementation, subject to parliamentary passage, of the Health and Care Bill.

Full details of these decisions and the decision process will be published on the Department of Health and Social Care section on the website shortly.