Governance

The NHS, local government and other local partners should agree the planned governance model for place including:

• Membership
• place-level decision-making arrangements, including any joint arrangements for statutory decision-making functions between the NHS and local government
• leadership roles, for convening the place-based partnership, as well as any individuals responsible for delegated functions
• representation on, and reporting relationships with, the ICP and ICB.

Membership

Whilst it is for the local partners to agree the appropriate organisations and individuals to be included in each place arrangement, it is best practice to consider how to include representation from the following:

• Primary care provider leadership, represented by PCN clinical directors or other relevant primary care leaders
• providers of acute, community and mental health services, including representatives of provider collaboratives where appropriate
• people who use care and support services and their representatives including Healthwatch
• local authorities, including Directors of Adult Social Services and Directors of Public Health and elected members
• social care providers
• the voluntary, community and social enterprise sector (VCSE)
• the ICB.

Place arrangements should agree which other community partners with an important voice or role should be involved, as members of committees or through other working groups and arrangements. This will depend on the objectives of the partnership, and may include housing associations, emergency services, prisons, universities and education providers.

In preparing for new statutory ICS arrangements for 2022/23 onwards, consideration has also been given on how best to engage the clinical and professional leadership of the devolved CCGs to support transition, and the ongoing development of the partnership.

Governance and decision-making arrangements

To date, place-based governance arrangements in ICSs have been informal forums for consultation and co-operation, where agreed actions are subsequently enacted through other governance arrangements.

In Staffordshire and Stoke-on-Trent, the health and wellbeing boards have provided a forum to align decision-making between local government and NHS partners.

Each place arrangement will consider, along with wider system partners, how to ensure governance and decision-making remains clear and proportionate and avoids duplication across the ICS, and how to share information and involve partners to promote joined-up decision-making.

Place partners will agree the membership of the different parts of the governance arrangements, recognising the different role partners play, and it may not be considered appropriate for some members to participate in some formal decision-making arrangements.

The shared decision-making arrangements agreed by place-based partners depend on continued mutual co-operation and agreement between partners, where all parties have trust and confidence in the arrangements. It is crucial therefore that the partnership agrees on the ways of managing disagreement and maintains a strong focus on organisational and cultural development and ways of working to ensure that trust, transparency and co-operation can be maintained.

Further interim guidance is available on the functions and governance of the ICB including technical guidance materials to support the delegation of statutory functions from local government or the NHS.