Up until 1st July 2022, Clinical Commissioning Groups were responsible for the planning and commissioning of health care services in local areas. Since 2016, health and care organisations have increasingly been working together in every part of England to coordinate services and to plan in a way that improves population health and reduces inequalities between different groups. The formation of non-statutory Integrated Care Systems (ICSs) has accelerated this change.
The Health and Care Act 2022 (the 2022 Act) amends the Health and Social Care Act 2012, abolishing Clinical Commissioning Groups (14Z27) and establishing statutory Integrated Care Boards (ICBs) and statutory Integrated Care Partnerships (ICPs).
Following the passing of this statute, the ICBs take on the commissioning functions of the CCGs as well as some of NHS England’s commissioning functions. However, an ICB is not simply a larger CCG but is expected to work differently in practice – its governance model reflects the need for integration and collaboration across the system. It has the ability to exercise its functions through for example, place-based or provider collaboratives (while remaining accountable for them) and it will also be directly accountable for NHS spend and performance within the system.
NHS England has set out the following as the four core purposes of ICSs:
- improve outcomes in population health and healthcare
- tackle inequalities in outcomes, experience and access
- enhance productivity and value for money
- help the NHS support broader social and economic development.
The ICB will use its resources and powers to achieve demonstrable progress on these aims, collaborating to tackle complex challenges, including:
- improving the health of children and young people
- supporting people to stay well and independent
- acting sooner to help those with preventable conditions
- supporting those with long-term conditions or mental health issues
- caring for those with multiple needs as populations age
- getting the best from collective resources so people get care as quickly as possible.
1.2.1 The name of this Integrated Care Board is NHS Hertfordshire and West Essex Integrated Care Board (‘the ICB’).
1.3 Area covered by the Integrated Care Board
1.3.1 The area covered by the ICB includes the Borough of Broxbourne, Borough of Dacorum, District of East Hertfordshire, District of Epping Forest, District of Harlow, Borough of Hertsmere, City of St Albans, Borough of Stevenage, District of Three Rivers, District of Uttlesford, Borough of Watford, and the Borough of Welwyn Hatfield. The ICB also covers part of the District of North Hertfordshire.
1.3.2 Lower Layer Super Output Areas (LSOAs) in the District of North Hertfordshire which are not covered by the ICB are provided at Appendix 3.
1.4 Statutory framework
1.4.1 The ICB is established by order made by NHS England under powers in the National Health Service Act (the 2006 Act).
1.4.2 The ICB is a statutory body with the general function of arranging for the provision of services for the purposes of the health service in England and is an NHS body for the purposes of the 2006 Act.
1.4.3 The main powers and duties of the ICB to commission certain health services are set out in sections 3 and 3A of the 2006 Act. These provisions are supplemented by other statutory powers and duties that apply to ICBs, as well as by regulations and directions (including, but not limited to, those made under the 2006 Act).
1.4.4 In accordance with section 14Z25(5) of, and paragraph 1 of Schedule 1B to, the 2006 Act, the ICB must have a constitution, which must comply with the requirements set out in that Schedule. The ICB is required to publish its Constitution (section 14Z29). This Constitution is published on the website at hertsandwestessex.icb.nhs.uk/us/constitution
1.4.5 The ICB must act in a way that is consistent with its statutory functions, both powers and duties. Many of these statutory functions are set out in the 2006 Act but there are also other specific pieces of legislation that apply to ICBs. Examples include, but are not limited to, the Equality Act 2010 and the Children Acts. Some of the statutory functions that apply to ICBs take the form of general statutory duties, which the ICB must comply with when exercising its functions. These duties include but are not limited to:
- having regard to and acting in a way that promotes the NHS Constitution (section 2 of the Health Act 2009 and section 14Z32 of the 2006 Act)
- exercising its functions effectively, efficiently and economically (section 14Z33 of the 2006 Act)
- duties in relation children including safeguarding, promoting welfare, etc (including the Children Acts 1989 and 2004, and the Children and Families Act 2014)
- adult safeguarding and carers (the Care Act 2014)
- equality, including the public sector equality duty (under the Equality Act 2010) and the duty as to health inequalities (section 14Z35)
- information law (for instance, data protection laws, such as the UK General Data Protection Regulation 2016/679 and Data Protection Act 2018, and the Freedom of Information Act 2000).
- provisions of the Civil Contingencies Act 2004.
1.4.6 The ICB is subject to an annual assessment of its performance by NHS England, which is also required to publish a report containing a summary of the results of its assessment.
1.4.7 The performance assessment will assess how well the ICB has discharged its functions during that year and will, in particular, include an assessment of how well it has discharged its duties under:
- section 14Z34, of the 2006 Act (improvement in quality of services)
- section 14Z35, of the 2006 Act (reducing inequalities)
- section 14Z38, of the 2006 Act (obtaining appropriate advice)
- section 14Z40, of the 2006 Act (duty in respect of research)
- section 14Z43, of the 2006 Act (duty to have regard to effect of decisions)
- section 14Z44, of the 2006 Act (public involvement and consultation)
- sections 223GB to 223N, of the 2006 Act (financial duties)
- section 116B(1) of the Local Government and Public Involvement in Health Act 2007 (duty to have regard to assessments and strategies).
1.4.8 NHS England has powers to obtain information from the ICB (section 14Z60 of the 2006 Act) and to intervene where it is satisfied that the ICB is failing, or has failed, to discharge any of its functions or that there is a significant risk that it will fail to do so (section 14Z61).
1.4.9 Each ICB and its partner local authorities will be required to establish an ICP, bringing together health, social care, public health (and representatives from the wider public space where appropriate, such as social care providers or housing providers).
1.4.10 The ICP will be tasked with developing a strategy to address the health, social care and public health needs of its system. The ICB and local authorities will have to have regard to that plan when making decisions.
1.5 Status of this Constitution
1.5.1 The ICB was established on 1 July 2022 by The Integrated Care Boards (Establishment) Order 2022, which made provision for its Constitution by reference to this document.
1.5.2 This Constitution must be reviewed and maintained in line with any agreements with, and requirements of, NHS England set out in writing at establishment.
1.5.3 Changes to this Constitution will not be implemented until, and are only effective from, the date of approval by NHS England.
1.6 Variation of this Constitution
1.6.1 In accordance with paragraph 15 of Schedule 1B to the 2006 Act, this Constitution may be varied in accordance with the procedure set out in this paragraph. The Constitution can only be varied in two circumstances:
- where the ICB applies to NHS England in accordance with NHS England’s published procedure and that application is approved
- where NHS England varies the Constitution of its own initiative (other than on application by the ICB).
1.6.2 The procedure for proposal and agreement of variations to the Constitution is as follows:
- The Chief Executive Officer may periodically propose amendments to the constitution that shall be considered and approved by the Board Members in accordance with the Standing Orders, prior to making an application in compliance with paragraph 1.6.2 (c) below; or
- At least half (50%) of all the board members formally request that the amendments for approval in compliance with paragraph 1.6.2 (c) below.
- Proposed amendments to this Constitution will not be implemented until an application to NHS England for variation has been approved.
1.7 Related documents
1.7.1 This Constitution is also supported by a number of documents that provide further details on how governance arrangements in the ICB will operate.
1.7.2 The following are appended to the Constitution and form part of it for the purpose of clause 1.6 and the ICB’s legal duty to have a constitution:
- Standing orders – which set out the arrangements and procedures to be used for meetings and the processes to appoint the ICB committees.
1.7.3 The following do not form part of the Constitution but are required to be published:
- Scheme of Reservation and Delegation (SoRD) – sets out those decisions that are reserved to the board of the ICB and those decisions that have been delegated in accordance with the powers of the ICB and which must be agreed in accordance with and be consistent with the Constitution. The SoRD identifies where, or to whom, functions and decisions have been delegated to.
- Functions and Decision Map – a high level structural chart that sets out which key decisions are delegated and taken by which part or parts of the system. The Functions and Decision Map also includes decision-making responsibilities that are delegated to the ICB (e.g. from NHS England).
- Standing Financial Instructions – which set out the arrangements for managing the ICB’s financial affairs.
- The ICB Governance Handbook – this brings together all the ICB’s governance documents so it is easy for interested people to navigate. It includes:
- the above documents a) – c)
- terms of reference for all committees and sub-committees of the board that exercise ICB functions
- delegation arrangements for all instances where ICB functions are delegated, in accordance with section 65Z5 of the 2006 Act, to another ICB, NHS England, an NHS trust, NHS foundation trust, local authority, combined authority or any other prescribed body; or to a joint committee of the ICB and one of those organisations in accordance with section 65Z6 of the 2006 Act
- terms of reference of any joint committee of the ICB and another ICB, NHS England, an NHS trust, NHS foundation trust, local authority, combined authority or any other prescribed body; or to a joint committee of the ICB and one or those organisations in accordance with section 65Z6 of the 2006 Act
- the up-to-date list of eligible providers of primary medical services under clause 3.6.2.
- Key policy documents, which are included in the Governance Handbook include:
- Standards of business conduct policy (incorporating the conflicts of interest policy and procedures)
- Policy for working in partnership with people and communities