What is the point of the NHS Integrated Care Board Plan?

This is about health inequality

When we at Leeds Beckett University interviewed Integrated Care Board(ICB) health inequalities leads as part of our work for the NHS Confederation one of the issues raised by an interviewee concerned Joint Forward Plans(JFP). These are produced every year, they set out what a particular ICB thinks the issues are and what actions they intend to take in response to these.

This health inequalities lead said:

“The joint forward plan is basically an NHS GCSE examination where there is a set of questions and there is a model answer and the model answer is the cultural norm that NHS England require. It doesn’t materially really affect the way the organisation behaves. It’s a necessary process that doesn’t add an awful lot of strategic value.”

Why read the JFP?

In my view the primary audience of a JFP should be local stakeholders not NHSE. Such stakeholders could be the manager of a local charity for example a Citizens Advice Bureau or a community anchor … or the clinical director for a primary care network.

They will want to know what the Integrated Care Board is doing about health inequalities and should feel it is worth reading the JFP to understand what NHS commissioners are planning to do and how this is relevant to their work. 

For the JFP to be relevant it needs to be:

Easy to navigate

You don’t want to have to read a lengthy document to try to find the bit that is relevant to you!

Clear about analysis and actions

The JFP must make it easy to see how the ICB priorities link to those of local stakeholders,  for example:

• How do they describe the health inequalities challenge?
• What actions are they proposing to take to tackle these?
• Who is responsible for these actions and how can they be influenced?

Most fundamentally how does this JFP help the reader to be better at tackling health inequalities in their role and how does it energise them and make them feel that the ICB is a potential collaborator?

I have had a quick look at two 2024/5 JFPs – one from South Yorkshire (SY) and one from North East London (NEL).

Length matters

• The NEL JFP is 59 pages
• The SY JFP is 89 pages

Description of place

Both plans take about the same number of pages in their description of their population. I think NEL is more sophisticated. It uses design and crisp analysis to give a real feeling for who lives there, the nature of the area and makes an honest statement about inequality. It also starts to flag up priorities.

SY is ok but it struggles to make the leap from (fairly standard) data to – analysis to – priorities for action. We don’t get as much of a feel for the characteristics of the population and the presentation lacks energy.

Actions

Both JFP have a section on health inequalities. Screenshots of the relevant pages are below. 

The NEL plan has a fairly explicit set of actions which are measurable. For example, allocating a specific amount of funding to each local authority area for health inequalities or supported discharge of the homeless.

The SY JFP is vague. Many of the ‘actions’ feel more like cultural ambitions and aren’t  measurable. For example, embed a cultural change, focus on improving, work collaboratively etc. They fail to move from broad generic statements that sound good to specific actions. It is really not possible to understand what their priorities are and hence specific actions.

Who is responsible?

So, you’ve read the plan – you want to clarify something or maybe challenge or disagree; who do you talk to?

The NEL JFP – flags up what appears to be a pretty inclusive heath inequalities steering group … although there is no direct reference to it on their website or any information about agendas and minutes.

I have been told that South Yorkshire ICB has a similar albeit less representative group – however there is no mention of it in the JFP or on their website.

Have you read your JFP? What do you think? Leave a comment on the blog!

Finally – a little caveat – I try to keep my blogs to less than 700 words – so they inevitably provide only a limited description and analysis of the issue I am writing about!