NHS England are right to question whether emerging integrated care boards with large memberships can be run effectively, a system leader in the capital has said.
Penny Dash, chair designate of North West London ICB, told delegates at a Public Policy Projects event this week: “At the moment, at our table, we have got about 30 seats around it and we have got many, many, many people frustrated that they don’t have a seat around that table.
“NHS England, I think rightly, are really starting to question [whether you] can be an effective unitary board, really taking appropriate responsibilities for spending five or six billion pounds of public money in order to improve the health of the population and everything else, with a board of that size.
“I think they are right to challenge that, so this is going to be really difficult.
“What I do think we absolutely need to do is make it really, really clear where all those voices fit in.”
Dr Dash, a former McKinsey partner, was responding to a question from the event’s chair Matthew Swindells about how ICBs could bring the third sector to the table.
The former NHSE deputy chief executive was appointed the chair of north west London’s four acute trusts in February this year.
She said she saw her role as creating “clarity” as to where individual groups of the workforce and specialists fit into the “jigsaw,” but was unsure how to do so without a “magic solution”.
However, she has told her board they needed to cover north west London’s entire health and care system, with someone “around the table who can solve each of [the] questions that different people have”.
She added: “That is the bit which, for me, is absolutely fundamental. I do not want to be in a place where something comes up and people all [say]: ‘That’s not me.’
“If you are not able to answer the question related to your remit then you shouldn’t be at the table. That’s really how we are trying to address it.”
The panel was then asked whether ICS sub-committees were the key to ensuring frontline clinical representation.
Dr Dash told delegates that, in her region, clinicians wanting to improve services for their population needed to speak with their trust’s chief executive as they would bring their view to the top table.
She said: “I am not setting up a sub-committee of the sub-committee of the sub-committee. One of the things I have spent the last few weeks doing is putting massive red lines through the sub-committee of the sub-committee of the sub-committee.
“Instead, I will be really clear the chief executive is around the table and the chief executive absolutely has the ability to redesign services, to improve services and so on. That is one answer.”
Arrangements will ‘look different’ across country
HSJ has approached North West London integrated care system for further comment.
Sarah Walter, director of the NHS Confederation’s ICS network, said system leaders across the country were in the process of establishing their ICS arrangements and this “will look different across different systems”.
She added: “Ultimately, they are all working to ensure they are improving health outcomes, tackling inequalities, enhancing productivity and value for money and helping the health service support broader social and economic development on behalf of the communities they serve.”