36 Suffolk and North East Essex ICS | ‘Our Journey Together’ together to contribute to enabling those outcomes. Actively working in this way meant that leaders in Suffolk and North East Essex understood that health and care operated less as a ‘mechanism’ and more as an ‘ecosystem’ with each element dependent on the others to achieve its aims. Stakeholders told us that genuinely understanding these interdependencies contributed to a shift in power to more equitable relationships with partners, and more investment in communities and community-based resources. Initially the informal ‘shadow ICS’ status for the system meant the ICS Board began essentially as a ‘coalition of the willing’. This forum enabled space for discussion and mutual challenge and ensured that the ICS continued to be focused on purpose and ‘start with why?’. These informal arrangements were replaced with the statutory arrangements of a split statutory ICP Committee and NHS ICB as set out in the Health and Care Act 2022xvii. Picture – Suffolk and North East Essex ICS Board in 2017 The statutory ICP Committee created in July 2022 aimed to build on the culture and role of the previous ICS Board. However, several stakeholders said that they thought on reflection that the original single ICS Board may perhaps have been more effective at enabling mutual challenge. They thought that after the governance split in 2022 into the separate ICB Board and ICP Committee, the opportunities to have broad based discussions and agree system-wide actions became more limited. Some stakeholders felt the ICB became more focused on delivery of NHS England plans and achieving financial balance, while the ICP became a forum to explore issues in depth but with more limited influence over the ICB than it had in the past. Stakeholders also highlighted that changing government policies had also influenced the direction and priorities of the ICB and led at times to short term crisis responses at the expense of longerterm prevention. These dynamics limited the ability of the ICS to achieve system-wide changes for local populations. A number of stakeholders underlined in particular the importance of people and communities having a voice and being able to influence ICS governance. Over time the ICS has developed increasing opportunities to actively listen to people and communities to understand their lives, challenges and needs, recognising that some groups and communities are underserved and ‘easily ignored’. For example, the recently convened ICS People and Communities Assembly now contributes to enabling diverse local voices to be heard. The NHS ICB, along with other system partners, has also increased the diversity of its non-executive members (NEMs), who not only contribute to the effectiveness of ICB governance but also regularly take part in the ICP’s campaigns and activities.
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