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Four ICS are placed in 'special measures'

As the new Integrated Care Systems are coming onto the NHS landscape this year, news broke this week that NHS England have already classed four of these as in need of "intensive mandated support" under their new Recovery Support Programme.

The new ICS organisations - Devon, Lincolnshire, Norfolk and Waveney and Shropshire, Telford and Wrekin - will now be subject to strict control measures, including having changes imposed by NHSE on the ICS board and executive team structures and appointing an 'improvement director' if they deem necessary. They can also bring in a consultative group to provide 'intensive support' as well as stringent approval processes in financial and decision-making.

It is understood that NHS England has already categorised the other 38 ICS groups into other support categories and a third of these will require some form of mandated support in their development into an approved organisation. This takes into account their previous ratings on financial performances as well as the quality ratings decided by the Care Quality Commission.

Some of the ICS regions have previously been under regulatory oversight - Devon have been subject to a version of special measures in 2015, NHSE describing this as a way of "addressing deep-rooted and systemic issues that previous interventions have not tackled".

Four acute trusts have also been put into these new measures of support - a Trust Board paper for Lincolnshire has suggested that they could leave these measures once financial and strategic plans were agreed; "As part of the Recovery Support Programme there was a need to agree the success and exit criteria which was predicated on the understanding that systems would be in the process for no more than 12 months.

"This would depend on the Trust exiting quality special measures and following a further CQC inspection, and the possibility of a 3-year financial plan being implemented by NHSE and delivering on financial targets. The third criteria would be having a strategic delivery plan in place that would take the Trust up to March 2024, although there will need to be official approval and sign-off by NHS England.

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