28 Suffolk and North East Essex ICS | ‘Our Journey Together’ Some stakeholders pointed out that there were also issues of coterminosity within the Suffolk and North East Essex ICS footprint where Alliance areas were based on historical NHS CCG footprints and did not always align with district council boundaries. A national review of ICS boundaries was undertaken in 2021 in anticipation of the new Health and Care Act the following year. In the East of England this review considered only two options which were either to retain the status quo in the interests of stability and building on trust and relationships, or to move to a county-based arrangement aligned to UTLA boundaries instead. Stakeholder views at that time generally recognised that addressing the wider determinants of health and wellbeing favoured alignment with UTLA boundaries. There were more mixed views on the impact of changing to county boundaries around addressing the quality of NHS services. Most NHS partners preferred stability and wanted to support sustainable use of NHS resources, particularly as the ICS boundaries aligned closely with flows for acute care, which is the largest area of NHS spend. However, given that the long-term financial sustainability of the NHS depends significantly on making a shift towards better primary and community provision and more spend on prevention and early intervention many considered that alignment should focus on populations rather than NHS acute flows. The outcome of the review in 2021 was an announcement by the then Minister of State for Health, Ed Argar MP that ICS boundaries in the East of England, including that for Suffolk and North East Essex, should remain as they were. Despite these difficulties there was always widespread recognition in Suffolk and North East Essex that with ICS boundaries there were no easy or ‘right’ answers and leaders remained united in their determination to find solutions and to make Integrated Care Systems work nonetheless. Some explicit steps that were undertaken to try to mitigate the impact of the challenge of coterminosity included: • Constant attention to ensuring equal involvement and inclusion of stakeholders from both Suffolk and Essex in system wide forums and decision making – even where this made forums very large; • An early and strong commitment to developing place-based working through local Alliances. This was further underlined by devolving NHS budgets to place level to enable pooled funding opportunities and formal shared leadership roles e.g. Alliance Directors who reported equally to the NHS ICB and also relevant local authorities; • A flexible approach to system governance embracing non-hierarchical principles and leaning into collaboration with neighbouring ICSs and supporting County based arrangements where that made most sense e.g. support to county based health and wellbeing boards; • Actively resisting the over-establishment of system level forums and mechanisms; • Reflecting place, county and system roles in staff structures, data reporting and other arrangements; • The decision to brand the ICS as ‘Can Do’ Health and Care was a positive attempt to focus on shared ambition rather than geographical identity; • Actively building relationships cross system through system learning and other programmes; • Moving events and meetings around the Suffolk and North East Essex area or holding them online. The eventual formation of NHS Suffolk and North East Essex ICB in 2022 created the only organisation to ever have a footprint coterminous with the ICS. Interestingly for some stakeholders this seemed to further compound confusion about the difference between the ICS and the NHS ICB and it would be common for stakeholders to mean the ICB when referring to ‘SNEE’ instead of the wider health and care system. The new ICB footprints that will be implemented from April 2026 will be coterminous with the planned new mayoral Strategic Combined Authorities in the East of England. Also within each of these wider footprints in the next two years UTLAs and district and borough councils will be replaced by fewer new single tier unitary authorities.
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