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The refreshed approach to quality risk management in Integrated Care Systems is based on three main levels of quality oversight and assurance:

  1. Routine quality assurance and improvement – day-to-day activity when there are no risks or minor risks which are being addressed effectively. Includes standard monitoring and reporting, due diligence and contract management including agreeing CQUIN schemes and production of quality accounts.
  2. Enhanced quality assurance and improvement – undertaken when there are system risks that are serious, complex and/ or recurrent
  3. Intensive assurance and improvement – a last resort, replacing previous Risk Summits, when there are very serious, complex or recurrent risks, which require intensive support from NHS England for recovery and improvement.

The approach taken to address the concerns – including the levels of assurance and improvement – must be agreed and confirmed by all key partners within the Integrated Care Board. 

System Quality Groups and Quality and Performance Committee

System Quality Groups (SQG) will provide a key forum within Integrated Care Systems to both share and triangulate intelligence, early warning signs and quality risks/ concerns; partners will develop and implement actions and responses to mitigate and address the risks raised.  Integrated Care Boards, or their committees with delegated responsibility for quality assurance, will have accountability for the effective management of healthcare risks. 

Bedfordshire, Luton and Milton Keynes has established a System Quality Group meeting. This meeting is executive led and will enable the system to identify risk and take actions as appropriate. The System Quality Group will report to the Integrated Care Board’s Quality and Performance Committee.   

The principal purpose of the Quality and Performance Committee will be to support continued improvements in quality, taking account of performance in the provider or the Integrated Care Board. 

System partners should escalate to System Quality Group and Integrated Care Board where appropriate. Specifically, the Quality and Performance Committee will be responsible for overseeing progress against milestones within the work plan. The focus will aim to improve system pathways across organisational boundaries and therefore the quality of delivery for the population.

The committee will aim to develop a culture of transparency and shared learning. 

CQC Position

A single assessment framework will be developed for health and social care providers, local authorities and integrated care systems.

Specifically for Integrated Care Systems the following themes will be assessed:


  • Shared direction and culture
  • Capable, compassionate and inclusive leaders
  • Governance and assurance
  • Partnerships and communities
  • Learning, improvement and innovation
  • Environmental sustainability
  • Workforce equality, diversity and inclusion.


  • Safe systems, pathways and transitions
  • Care provision, integration and continuity
  • How staff, teams and services work together.

Quality and safety

  • Learning culture
  • Supporting people to live healthier lives
  • Safe and effective staffing
  • Safeguarding
  • Equity in access
  • Equity in experiences and outcomes
  • Shared learning, escalation of concerns.

Provider CQC Position

It is worth noting that despite the changes in regulations, providers still remain ‘sovereign’ organisations responsible for assuring the quality of their own services and have robust governance structures in place.