Lewisham's Integrated Care Board (ICB) is set to undergo significant governance changes aimed at streamlining services and enhancing collaboration between local health and care partners. These reforms are being driven by national NHS reforms, including the 10-year NHS plan, the ICB blueprint, and the development of a new Neighbourhood Health and Care Service, which collectively aim to shift focus from treatment to prevention and from hospital-based care to community-based services.
The proposed restructuring, discussed at a recent Health and Wellbeing Board meeting, will see the disestablishment of the Lewisham Local Health and Care Partnership (LHCP) Board. The LHCP Board will cease to be a subcommittee of the ICB Board from October 2026, with its functions being phased out over time as partnership governance evolves.
Functions previously held by the LHCP Board will be distributed across three key bodies: the Health and Wellbeing Board, a new Joint Commissioning Group, and the Integrated Neighbourhood Committee. This move is intended to reduce duplication, ensure decisions are made at the most appropriate level, and improve the effectiveness of partnership working.
The Health and Wellbeing Board will assume responsibilities for strategic planning and oversight, aligning with its existing role in partnership working. The Joint Commissioning Group will focus on translating strategic plans into commissioning priorities. The Integrated Neighbourhood Committee, a newly established group, will oversee the delivery of Integrated Neighbourhood partnership functions.
Concerns were raised during the meeting regarding a potential reduction in transparency with the loss of public meetings previously held by the LHCP Board. However, assurances were given that engagement and reporting mechanisms would be strengthened. The proposed 'Engagement Hub' will coordinate neighbourhood engagement activity, support co-production with residents and communities, provide a consistent route for community feedback and insight, strengthen collaboration with VCSE partners and community organisations, and ensure community voices inform strategic decision-making and neighbourhood delivery. The hub will also provide transparent accountability to the Integrated Neighbourhood Committee and report into the Health and Wellbeing Board.
The Place Executive Lead (PEL) continues to hold delegated authority and accountability from the SEL ICB Board for community-based services and budgets. This authority is enacted through the Lewisham commissioning function, the Lewisham SMT, and through direct accountability to the ICB CEO. Decision-making for delegated functions will be enacted partly through the commissioning board and commissioning decisions, and partly through the PEL's own senior management team. Financial decision-making processes for health or the council remain unchanged and are not delegated to the Health and Wellbeing Board.
The new structure aims to integrate wider determinants of health, such as housing and employment, into the commissioning and delivery of care by strengthening representation from the housing directorate on the Health and Wellbeing Board and by embedding a Health in All Policies (HiAP) approach. The Health and Wellbeing Strategy has housing as a priority action area, with initiatives like a damp and mould pathway and joint health and housing working protocols. The Integrated Neighbourhood Teams (INTs) will also include representatives for housing and employment.
The success of these reforms will be measured through various metrics. For the Health and Wellbeing Strategy, the Local Government Outcomes Framework (LGOF) public health indicator data is noted, which includes metrics such as healthy life expectancy, alcohol-specific mortality, and under-18 conception rates. For the Better Care Fund, key metrics include emergency admissions for those over 65, discharge delays, and care home admissions. The Integrated Neighbourhood Committee will be responsible for securing delivery of agreed strategic and operational plans and achieving agreed outcomes and KPIs. The Lewisham Neighbourhood Programme Board will monitor programme risks, dependencies, performance, and benefits realisation, with success measures including improved integrated working, improved patient outcomes and experience, reduction in duplication, and progress against neighbourhood transformation priorities and population health outcomes.
The ICB's Lewisham Neighbourhood Development Team will transfer to LGT in April 2027 to continue working on behalf of the partnership. The proposed changes aim to reduce duplication and ensure decisions are made at the most appropriate level, which may impact how staff roles are structured and how functions are carried out, though specific details on the anticipated impact on existing staff and roles are not extensively detailed.