Checklist for Trusts before 1 July 2022

27 June 2022

With just four days to go before England’s 42 integrated care systems move to a statutory footing, GGI presents a checklist of focus areas for trusts as they move into the uncharted waters of integrated care. Whilst the legislative changes may seem focused on the transition from CCGs to ICBs, the impact on NHS trusts is significant and also opens up opportunities for Trusts to operate as system leaders and take on commissioning functions in order to deliver better outcomes for their local communities.

All Trust Boards should be clearly sighted on the opportunities and risks and have formally considered a range of key issues through their board development programme and business meetings. We have developed a checklist and associated guidance based on six 'key lines of inquiry', which should help Boards position themselves to take advantage of the opportunities and mitigate the risks.

All Boards should have:

  1. A developed vision and strategy that is focused on improving outcomes for local communities and is aligned with the ICB and system partners. Is your trust’s vision outward looking and embrace the triple aim of improving patient experience, improving population health, and improving value? Is planning done jointly with system partners and clearly demonstrate how improved outcomes will be delivered for local populations?
  2. Clear current arrangements and a future vision for the trust’s role in the system, place-based partnerships and provider collaboratives. Have governance and working arrangements for 1 July been formally considered by the board? Is the Board clear about where and how key decisions will be taken in the system, and the Board's role in that?
  3. An assessment of the trust’s role and responsibilities in system oversight and risk frameworks, incorporated in agreed documents and processes. Have you agreed arrangements within the trust, as part of a place-based partnership, and at a system level? Do partners collaborate to manage key system risks and are rules of escalation clear?
  4. A revised board development programme and operation of the board, committees and operational structures that reflects the role in the system. Does your programme reflect changing the roles and responsibilities, have the new statutory duties required of NHS trusts been considered and changes implemented? Are your forward agenda and reporting plans aligned with the ICS?
  5. Initial assessment of the requirements to be a well-led board in an ICS, in line with the CQC’s emerging framework for regulation of systems. Have you conducted a well-led assessment through a system lens (board reporting, leadership etc.), and have you conducted a 360-degree feedback exercise to inform your discussions and development?
  6. A revised governance handbook with appropriate changes. Have you made the necessary changes to your constitution, code of conduct, and board and committee terms of reference. has your scheme of delegation and conflict of interest policy been revised in order to enable Trust officers to operate in the system whilst protecting the important role of the Board?

The time is now for NHS Trusts to step up and build on their expertise of providing NHS services to improve outcomes for whole populations. GGI was well placed to help Boards prepare for and navigate this challenge etc.

Prepared by GGI Development and Research LLP for the Good Governance Institute.

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