Part 1: Health Service in England: Integration, Collaboration and Other Changes Integrated Care Boards: Functions Section 25: General functions
Duty to promote the NHS Constitution. Section 14Z32 imposes a duty upon each integrated care board both to act in the exercise of its functions (for example through their commissioning functions) with a view to securing that health services are provided in a way that promotes the NHS Constitution and to promote awareness of the NHS Constitution among staff, patients and the public. This means that not only must integrated care boards act in accordance with the NHS Constitution, but they should ensure that people are made aware of it. They may also do this by contributing, as far as possible, to the advancement of the Constitution’s principles, rights, responsibilities and values, through their actions.
	Duty as to effectiveness, efficiency etc. Under section 14Z33, each integrated care board must exercise its functions effectively, efficiently and economically.
	Duty as to improvement in quality of services. Section 14Z34 places integrated care boards under a duty to exercise their functions with a view to securing continuous improvement in the quality of services provided to individuals, as part of the health service. Under section 14Z34(3) integrated care boards should, in particular, look to continuously improve effectiveness of services, safety of services and patient experience.
	Duties as to reducing inequalities. Section 14Z35 sets out that integrated care boards must, in the exercise of their functions, have regard to the need to reduce inequalities between persons in relation to their ability to access health services and in the outcomes achieved from health services. Section 14Z35 (b) makes explicit that these outcomes for patients includes outcomes such as the quality of experience undergone by patients as described in section 14Z34(3).
	Duty to promote involvement of each patient. Section 14Z36 requires integrated care boards to, in the exercise of their functions, promote the involvement of patients and their carers and representatives in decisions about the provision of health services to patients. The reference to "carer" would include young carers and parent carers who provide care, unpaid, for a friend or family member who has needs, for example, arising from a disability, impairment or long-term health condition.
	Duty as to patient choice. Section 14Z37 imposes a duty on integrated care boards, in the exercise of their functions, to act with a view to enabling patient choice (for example, by commissioning so as to allow patients a choice of treatments, or a choice of providers, for a particular treatment).
	Duty to obtain appropriate advice. Section 14Z38 requires integrated care boards to obtain appropriate advice from people who, collectively, have a broad range of professional expertise in relation to the prevention, diagnosis or treatment of illness, and the protection or improvement of public health to enable them to discharge their functions effectively. This could involve, for example, an integrated care board employing healthcare professionals to advise the integrated care board on commissioning decisions for certain services, or appointing professionals to any committee that the integrated care board may set up to support commissioning decisions. It could also involve consulting clinical networks and senates.
	Duty to promote innovation. Section 14Z39 imposes a duty on integrated care boards, in the exercise of their functions, to promote innovation in the provision of health services including in making arrangements for the provision of health services.
	Duty in respect of research. Section 14Z40 puts a duty on integrated care boards in respect of research. Each integrated care board must, in the exercise of its functions, facilitate or otherwise promote health research and the use of evidence obtained from research. The aim of this section is to further embed research in the health and care system.
	In practice, each integrated care board could exercise its duty to facilitate or otherwise promote research and the use of evidence obtained from research by:
considering research when exercising its commissioning functions, both in terms of ensuring that the services commissioned have been informed by the evidence obtained from research and in selecting providers who are research-active;
encouraging its providers to be actively involved in the delivery of research and to provide services that are informed by evidence from research;
having a dedicated research office/team providing support for research;
articulating local research needs when assessing local needs, articulating plans for addressing these when preparing strategies and plans, and encouraging its partner organisations to play an active and collaborative role in pursuing these;
having Board-level discussions on research activity, the use of the evidence from research, the research workforce, and research culture within the integrated care system; and/or
where appropriate, exercising the duty to facilitate or otherwise promote research in conjunction with its power to conduct, commission or assist the conduct of research (paragraph 13(1) of Schedule 1 of the NHS Act 2006), for example by hosting or being a collaborating partner in research infrastructure.
	Duty to promote education and training. Section 14Z41 puts a duty on integrated care boards in respect of education and training. Each integrated care board must, in exercising its functions, have regard to the need to promote education and training for persons who are employed, or who are considering becoming employed, in an activity related to the provision of services as part of the health service in England, so as to assist the Secretary of State and Health Education England in the discharge of the duty under section 1F.
	Duty as to promoting integration. Section 14Z42 requires integrated care boards to exercise their functions with a view to ensuring that health services are integrated with the provision of social care and health-related services where this would improve the quality of the services, reduce inequalities of access or reduce inequalities in outcomes; under this integration can be integration of health services with other health services or health services with health-related services (such as housing services), or health services with social care services.
	Duty to have regard to effect of decisions. Section 14Z43, sets out a new duty, which also applies to the other "relevant bodies". The "relevant bodies" are NHS England, NHS Trusts in England and NHS Foundation Trusts.
	This duty has been described operationally as the "triple aim" duty.
	Subsection (1) provides that integrated care boards will be under a duty, in making a decision about the carrying out of their functions, to have regard to all likely effects of their decisions on three areas: the health and well-being of the people of England (paragraph (a)), the quality of services provided or arranged by relevant bodies (paragraph (b)) and the efficiency and sustainability of resources used by the relevant bodies (paragraph (c)).
	The reference in the subsection to "all" likely effects means that the integrated care board will have to consider, under paragraphs (b) and (c), the effects of the decision both on its own quality of services and resource use and those of other relevant bodies.
	Subsection (2) excludes decisions relating to services provided to a particular individual (e.g. individual clinical decisions or highly specialist commissioning decisions concerning an individual patient) from this duty. Under subsections (b) and (c), it also specifies that when complying with Triple Aim duty, integrated care boards must consider inequalities in health and well-being and the benefits obtained from services.
	Subsection (3) provides that integrated care boards must have regard to guidance on the discharge of this duty published by NHS England under new section 13NB.
	Duties as to climate change: Section 14Z44 introduces a new duty on Integrated Care Boards that requires each integrated care board to have regard to how it can best support the achievement of the government’s legislative targets regarding the environment and climate change. These are specified as: the target set under Section 1 of the Climate Change Act (the Net Zero emissions targets, currently set for 2050) and the targets due to be set under Section 5 of the Environment Act, which pertain to such matters as air quality, water quality and species abundance (among others). In addition, the duty requires each integrated care board to have further regard to how it may support efforts to adapt to the predicted impacts of climate change as set out in reports brought forward under section 56 of the Climate Change Act. The duty applies when an integrated care board exercises all of its functions. Subsection (2) of the duty requires integrated care boards to have regard to any guidance issued by NHS England under section 13ND on how it is to discharge this duty.
	Public involvement and consultation by integrated care boards. Section 14Z45 sets out requirements for involving the public (whether by consultation or otherwise). Integrated care boards must make arrangements to involve individuals to whom services are being or may be provided in the commissioning process. Under section 14Z45(2), arrangements must be made to secure the involvement of individuals and their carers and representatives in planning commissioning arrangements; in developing and considering proposals for changes in the commissioning arrangements, where those proposals would have an impact on how services are provided or the range of health services available; and in decisions that would likewise have such an impact. Under section 14Z45(3), this duty does not apply in cases where a trust special administrator drafts a report concerning an NHS Trust or Foundation Trust and NHS England and the Secretary of State have already made decisions about actions to take.
	Joint exercise of functions with Local Health Boards. Regulations may be made under section 14Z46(1) to allow any prescribed functions of an integrated care board to be exercised jointly with a Local Health Board. Local Health Boards are the bodies responsible for commissioning and providing health services in Wales. Regulations may also make provision for any such functions to be exercised by a joint committee of the integrated care board and the Local Health Board. Subsection (3) makes it clear that these arrangements do not affect any liabilities of integrated care boards arising from the exercise of its functions under arrangements with a Local Health Board. Such regulations would be subject to the negative procedure.
	Raising additional income. Section 14Z47 allows integrated care boards to raise additional income for improving the health service, provided that this does not significantly interfere with the integrated care board’s ability to perform its functions.
	Power to make grants. Section 14Z48 allows integrated care boards to make grants or loans, subject to such conditions as the integrated care board deems appropriate, to NHS trusts, NHS foundation trusts, or voluntary organisations that provide or arrange for the provision of services similar to the services in respect of which an integrated care board has functions.
	Duty to keep experience of members under review. Section 14Z49(a) requires an integrated care board to keep under review the skills, knowledge and experience that it considers, when taken together, necessary for the members of the board to have in order for the board to effectively carry out its functions. Section 14Z49(b) requires the board to take such steps as it considers necessary to address or mitigate the shortcoming that they identified. This could, for example, be through the membership or through taking expert advice.
	Responsibility for payments to providers. Section 14Z50 (1) provides that NHS England may publish a document specifying the circumstances in which an integrated care board is liable to make payments to a provider to pay for services provided under arrangements commissioned by another integrated care board. This would, for instance, enable NHS England to specify that, where a person uses an urgent care service commissioned by an integrated care board other than the integrated care board that is ordinarily responsible for that person’s healthcare, the cost of that service is charged to the latter integrated care board. It could, for instance, decide that integrated care boards should be left to agree mutual arrangements for sharing costs where patients from a number of different integrated care boards use the same urgent care service. Where NHS England publishes such a specification, an integrated care board will be required to make payments in accordance with that document (subsections (2) and (3)). In those circumstances, no other integrated care board will be liable for the payment. Any sums payable by virtue of subsection (2) may be recovered under subsection (5) as a civil debt. Where NHS England makes a specification, it may publish guidance for the purpose of assisting integrated care boards to understand and apply it (subsection (6).
	Guidance by NHS England. Section 14Z51 stipulates that NHS England must publish guidance for integrated care boards on the discharge of their functions. Integrated care boards must have regard to this guidance.
	Joint forward plans for integrated care board and its partners. Section 14Z5214Z52 makes provision with regard to commissioning plans. Subsection (1) stipulates that each integrated care board, and its partner NHS trusts and NHS foundation trusts, must prepare a plan before the start of each financial year to set out how they propose to exercise their functions over the next 5 years. In practice, it is expected that this plan will set out how an integrated care board will meet the health needs of its population and this will include primary, community and acute care. Under subsection (2((a) the joint forward plan for an integrated care board and its partners must describe the health services that the board proposes to commission over the period. Under subsection(2)(b), the plan must, in particular, explain how the integrated care board proposes to discharge each of its duties under sections 14Z34 to 14Z45 (general duties of integrated care boards) and sections 223GA to 223N (financial duties). These general duties sections cover: continuous improvement in the quality of services; reducing inequalities; promoting involvement of each patient; enabling patient choice; obtaining appropriate advice; promoting innovation; facilitating or otherwise promoting research and the use of evidence from research; promoting education and training; promoting integration, how it will fulfil its duty to have regard to the wider impact of decisions have regard to certain matters relating to the environment, including climate change; and ensure public involvement and consultation. Under subsection (2)(c), it must also reference how the plan implements any relevant joint local health and wellbeing strategies to which the integrated care board is required to have regard. Under subsection (2)(d), the forward plan must also set out any steps the integrated care board proposes to take to address the particular needs children and young persons under the age of 25 and under subsection (2)(e) the steps it proposes to take to address the particular needs of victims of abuse.
	Under subsections (3) and (4), this plan must be published and sent to NHS England, the relevant integrated care partnership and any relevant Health and Wellbeing Boards. NHS England may specify a date by when this must be done under subsection (5). An integrated care board and its partner NHS trusts and NHS foundation trusts must have regard to the plan (subsection (6)).
	Revision of forward plans. Under Section 14Z53, the forward plan may be revised. Should the proposed revision be deemed "significant", the integrated care board must publish the revised plan and give a copy to the integrated care partnership, NHS England and the relevant health and wellbeing board. Under subsection (3), where the integrated care board revises the plan and the changes are not significant, it must publish a document setting out the changes and give a copy of that document to the integrated care partnership, each relevant health and wellbeing board and NHS England.
	Consultation about forward plans. Under section 14Z54, when preparing a forward plan, or making a change it deems significant, the integrated care board must consult individuals for whom it has core responsibility for and any other persons they consider it appropriate to consult.
	Under subsections (3) and (4), the integrated care board must also provide relevant Health and Wellbeing Boards with a copy of the draft plan or revised plan (as the case may be) and consult on whether the plan adequately takes the latest joint health and wellbeing strategy into account.
	Under subsections (5) and (6), the Health and Wellbeing Board is required to respond with its opinion on the matter it is consulted upon and may also give its opinion to NHS England. Where a Health and Wellbeing board gives an opinion to NHS England, it must inform the integrated care board and its partner NHS trusts and foundations trusts. Under subsection (7), if the integrated care board went on to make further changes to the forward plan, this process would have to be repeated. The revised plan would have to be published and a copy given the relevant Health and Wellbeing Board and NHS England.
	Under subsection (8), all published forward plans must include:
a summary of the views of individuals consulted;
an explanation of how those views were taken into account; and
a statement as to whether the relevant Health and Wellbeing Board(s) agreed that the plans have due regard to the joint health and well-being strategy or strategies.
	Opinion of Health and Wellbeing Boards on forward plan. Section 14Z55 allows each Health and Wellbeing Board to provide NHS England with its opinion on whether an integrated care board’s forward plan has taken proper account of the relevant joint health and wellbeing strategy. If it does so, it must provide a copy of this opinion to the integrated care board in question.
	Joint capital resource use plan for integrated care board and partners. Section 14Z56 stipulates that before the start of each financial year, an integrated care board and its partner NHS trusts and NHS foundation trusts must prepare a plan setting out their planned capital resource use. Subsection (2) provides that the plan must relate to such a period as the Secretary of State may direct (and such a direction must be published (subsection (3)). The plan must be published (subsection (4). Under subsection (5), the integrated care board and its partner NHS Trusts and Foundations Trusts must give a copy of the plan to the integrated care partnership, each relevant Health and Wellbeing Board and NHS England. NHS England can publish guidance about the discharge of functions under this section under subsection (7) and the integrated care board and its partner NHS trusts and foundation trusts must have regard to such guidance (subsection (8)).
	Under subsection (9), NHS England may give directions, in relation to a financial year-
specifying descriptions of resources which must, or must not, be treated as capital resources for the purposes of this section;
specifying uses of capital resources which must, or must not, be taken into account for the purposes of this section.
	Under section 14Z57, a plan published under section 14Z56 can be revised. Any revisions the integrated care board and its partner NHS trusts and foundation trusts consider significant must be published and a copy provided to NHS England, the integrated care partnership and each relevant Health and Wellbeing Board. Under subsection (3), where the revised plan does not contain significant changes, the integrated care board and its partner NHS trusts and foundation trusts must publish a document setting out the changes and give a copy of that document to the integrated care partnership, each relevant health and wellbeing board and NHS England.
	Annual report Section 14Z58 stipulates that an integrated care board must, in each financial year, prepare a report on how it has discharged its functions in the previous financial year. Under subsection (2) an annual report must, in particular, explain how the integrated care board proposes to discharge each of its duties under sections 14Z34 to 14Z45 facilitating or otherwise the use of from research. The report must also review to what extent the integrated care board has exercised its functions in accordance with its forward plan and capital resource use plan, as well as to what extent it has implemented any relevant health and wellbeing strategies. Under subsection (3), in producing the report, the integrated care board must consult each relevant Health and Wellbeing Board. Under subsection (4) the annual report must include a statement of the expenditure incurred by the integrated care board during the financial year that relates to mental health and an explanation of the statement and calculation. NHS England may give directions to integrated care boards as to the form and content of the report (subsection (5)). The integrated care board must also publish the annual report and give copies to NHS England by a date specified by NHS England (subsection (6)).
	Performance assessment of integrated care boards. Section 14Z59 stipulates that NHS England must conduct a performance assessment of each integrated care board in respect of each financial year.
	Under subsection (3), the assessment must, in particular, include an assessment of how well the integrated care board has discharged its duties concerning the improvement in quality of services (section 14Z34), reducing inequalities (section 14Z35), obtaining appropriate advice (section 14Z38), having regard to effect of decisions (section 14Z43), public involvement and consultation (section 14Z45), financial duties (sections 223GB to 223N) and the duty to have regard to assessments and strategies (section 116B(1) of the Local Government and Public Involvement in Health Act 2007).
	Under subsection (4), in producing the report, NHS England must consult each relevant Health and Wellbeing Board as to its views on the any steps that the board has taken to implement any relevant joint local health and wellbeing strategy. NHS England must also have regard to any guidance published under section 14Z51 or any guidance published by the Secretary of State (subsection (5)). NHS England must publish a report in respect of each financial year containing a summary of the results of each performance assessment conducted by NHS England in that year (subsection (6)).
	Power of NHS England to obtain information: Under section 14Z60, NHS England may require an integrated care board to provide NHS England with any necessary documents or other information.
	Power to give directions to integrated care boards: Section 14Z61 applies if NHS England considers an integrated care board to be failing or to have failed to discharge any of its functions, or that there is a significant risk that an integrated care board will fail to do so. Subsection (2) provides that NHS England may direct an integrated care board to discharge those functions in a specified manner within a specified period.
	Under subsections (3), (4), (5) and (6), NHS England may:
direct the integrated care board or chief executive of the integrated care board to ceases to perform any of its functions.
terminate the appointment of the chief executive and direct the chair and other members of the board to appoint a replacement of their direction.
exercise any function on behalf of the board or direct another integrated care board to perform functions specified by NHS England.
exercise any functions of the chief executive or direct a chief executive of another integrated care board to perform functions specified by NHS England.
	Under section 14Z62, before giving directions under section 14Z61(5)(b) or (8)(b) NHS England must consult the integrated care board to which it is proposing to give the direction or to whose chief executive it is proposing to give the direction (subsection (1)). The integrated care board is required to cooperate with any chief executive who is directed to exercise its functions (subsection (2)).Permitted disclosures of information: Section 14Z63 stipulates that integrated care boards are permitted to disclose information obtained in the exercise of its functions in the circumstances listed in subsection (1).
	Interpretation: Section 14Z64 defines the terms used in the chapter.
	Subsection (3a) inserts subsection (1A) after subsection (1) of section 48 of the 2006 Act requiring partner NHS foundation trusts to share any information required by integrated care boards with them.
	Subsection (3b) substitutes subsection (2) of section 48 of the 2006 Act requiring partner NHS foundation trusts to provide information in such form, and at such time or within such period, as may be specified by the person imposing the requirement.
	Subsection (4a) converts the existing provision in paragraph 13 of Schedule 4 to sub-paragraph (1).
	Subsection (4b) inserts sub-paragraph (2) in paragraph 13 of Schedule 4 requiring partner NHS trusts to share any information with its partner integrated care board that it requires and inserts subsection (3) in paragraph 13 of Schedule 4 which requires information in subsection (2) to be submitted in such form, and at such time or within such period, as may be specified by the integrated care board.