Rachel Power’s blog, Health must be at the heart of all government policies, focusses on effecting change at a national level, but the other route to effect change is locally. As always it is best to tackle any problem in as many ways as possible and the Integrated Care Board (ICB) meeting is your opportunity. The ICB is responsible for commissioning; it funds care provided by the various healthcare providers such as hospital trusts, community trusts and so on.

ICBs in England meet in public monthly or more lately alternate months. If my ICB is typical, its meeting in public but it is not a public meeting; the public cannot speak to the meeting, although this appears to be changing as the public is now allowed to speak at a pre-meeting session by prior agreement. 


There is also, the right to submit a written question to the ICB, which will be published in the minutes alongside the ICB’s response. And of course, you can buttonhole the relevant person before or after the meeting. This questioning route can be very time efficient, you do not need to attend the meeting, which can be anywhere in your ICB area. There are rules for submitting a written question, these will be available on the ICB website; of particular importance is the time deadline.

The meeting papers are extensive and available prior to the meeting on the ICB website. The meeting is live and recorded on YouTube. My local ICB meetings can be watched online, so you don’t have to attend in person; I am sure this is standard practice in other ICB. In the past I have cut the grass while listening to the meeting on my mobile!

Personally, I am very selective when reading the papers /watching YouTube. I tend to stick with the Chair’s Report and the Chief Executive’s report and anything on the agenda that’s of personal interest.

Critical friend

I think I am a critical friend to the NHS – and perhaps more people in this role is what is needed. Maybe we should consider the NHS as we do any other service such as our bank, water and electricity suppliers and others. I have always found the frontline staff to be accommodating so far as they are able, and my experience of the NHS is perfectly acceptable on most occasions, but sometimes it isn’t, like any other service.

Waiting list reduction needs patient input at ICB level and nationally. The Institute of Fiscal Studies report of February 2024 The past and future of NHS waiting lists in England (ifs.org.uk) does not paint a rosy picture, this has got to be improved. The report has a Key Findings section that provides a useful summary.

One current issue I have is that the ICB meeting is not patient focussed.  Each meeting includes a detailed financial review against a target yet there is no mention of a waiting list reduction plan to meet the 18 weeks target or cancer targets.  While finance is important, the reason for the NHS is to care for patients. But the patient has paid in advance, cannot withhold or change their subscription plan or provider and is generally too accepting of the situation. This, I believe is why there is a lack of patient centricity once we move away from the patient facing health professional.


I would encourage you to check your ICB minutes, available on your ICB website, for progress on the waiting list reduction plan. If you don’t see it reported or insufficient progress being achieved, then that is the time to ask the question where is the waiting list reduction plan and when will it be published in the ICB papers, if it’s not available. If it is available is progress as expected, if not say so and ask what remedial action the ICB is taking. I would expect the plan to include the length of the waiting list in weeks and the projected target date to reach 18 weeks.

Be prepared to be politely insistent. I take the view that if there is no plan then the ICB is failing to manage the commissioning of your care, and personally I have no problem saying so.

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