East of England Boundary Review

The Challenge

In April 2021, Tricordant was commissioned by NHS England and Improvement East of England to undertake a rapid Review of the Integrated Care System (ICS) boundaries across the East of England, focusing on 4 ICSs which were not coterminous with upper-tier local authorities. This highly politically sensitive project involved working with ICS chairs and executive leads, local authority leaders and chief officers, NHS provider chief executives and a wide range of interested senior stakeholders.

Our Approach

We facilitated the production of a final report which identified the issues, risks and opportunities with both a status quo and change option to achieve coterminosity at both an overall generic strategic level and for each individual system. Our work focussed on 4 key areas around:

• Governance and system working arrangements
• Population health and wellbeing focus
• Development and provision of health and care services
• Relationships, trust and ways of working

Although there were significant differences in the position of the four ICSs, four county councils and two unitary authorities involved, all parties were able to agree the report was a fair and balanced representation of the 2 options, and it was submitted to the Secretary of State in early June.

The Results

The Report was subsequently discussed in parliament.

The report had been commissioned and submitted under one Secretary of State, Matt Hancock, but the final decision on ICS boundaries nationally was taken by a different Secretary of State, Sajid Javid. https://www.gov.uk/government/publications/integrated-care-systems-boundaries-review-decision-summary/integrated-care-systems-boundaries-review-decision-summary   He broadly decided to retain the status quo.

The learning from the review and analysis developed mitigations to the risks arising from the status quo option chosen, particularly in the 4 key areas of exploration. Subsequently, as they have been established each ICS and constituent partners have had to manage the issues and risks identified with a mixed range of success. We will never know if the decision may have been different if Mr Hancock had remained in post! If the option for co-terminosity had been chosen, inevitably a different set of mainly more operational challenges would have presented themselves.

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