The Secretary of State made a statement in the Comms this morning (Thursday 11th Feb 2021) on the white paper for a new Health and Social Care Bill. The white paper has now been published and a bill is expected later in the year. The title Integration and Innovation: working together to improve health and social care for all sums up some of the main content. Although there isn’t an awful lot that’s new, there are some changes of tone.
To sum up some of the main things we already knew or expected:
• “NHS England and NHS Improvement to form one body (which will be known as NHS England)
• ICSs to be made up for two parts: ICS NHS boards and Health and Care Partnerships with the boards taking over CCG functions
• The removal of the requirement to procure in many cases – also the option remains open for a decision locally
• The NHS mandate to become more flexible and so won’t be reviewed every year, and Healthwatch England remains a statutory consultee
• Increased powers for the Secretary of State (SoS)
• Arm’s Length Bodies’ functions will become transferable (and redundant bodies can be abolished)
• New arrangements to be developed for service reconfiguration – and this includes local authorities losing the right of referral
• A legal framework for Discharge to Assess so that NHS continuing healthcare (CHC) and NHS Funded Nursing Care) assessments, and Care Act assessments can take place after discharge
• NHS able to delegate its functions to ICS (including jointly)
• Improved data sharing – based on anonymous data – to help the overall system
• CQC to have enhanced role in reviewing system working, which will allow the SoS to intervene where the local authority is not meeting its duties
• Public health interventions focused on fluoridation and food labelling
• The Health Services Safety Investigation Body (HSSIB) to be established
• Flexible and proportionate regulation, with the ability to rationalise the number of professional regulators and to remove or add professions
• Remove barriers to integration through joint committees, collaborative commissioning approaches and joint appointments
• The Government again commits to bring forward additional plans for social care reform later this year.
Those are the highlights but there is a lot more detail – and many areas where further proposals will be brought forward. It’s a complex picture and one that will be developing while the system is dealing with the pandemic.
The underlying themes are:
• Increased powers for the SoS including the ability to give direction to NHSE
• ‘Primacy of place’ – focusing decision-making at the most local level possible
• Local determination of arrangements – recognising that one size doesn’t fit all, local system would be able to make decisions about their governance
• Integration is seen at two levels: integration within NHS and integration with external organisations.
• ‘Removing bureaucracy’ with a specific focus on data sharing within the system, workforce deployment and in competition around commissioning
This builds on the work the system has been doing since the publication of the NHS Long Term Plan, and is in line with NHS England’s recommendation in their recent document, formally recognising the need to bring together NHS organisations, local government and wider partners at a system level to deliver more joined up approaches to improving health and care outcomes, coterminous with local authorities.
If ICSs are to become conterminous with local authorities (several local authorities in many cases), that will mean a bit of moving around the pieces in areas such as Essex where the local authority feeds into thee ICS areas.
The Government has not yet set out a timetable for the legislation but the white paper indicates that they would like to begin implementation of the proposed changes by 2022.
Click HERE or on the image above to read the document “Integration and innovation: working together to improve health and social care for all”