What the government’s new whitepaper proposes for integrated care
With the push towards increased collaboration between health and social care, the Department of Health and Social Care (DHSC) has published an important new whitepaper that sets out legislative proposals for a Health and Care Bill.
Called ‘Integration and innovation: working together to improve health and social care for all’, the paper details proposals for NHS and social care reform, with a focus on collaboration between the NHS, local government, and delivery partners.
On current timeframes and subject to Parliamentary business, the department plans for the legislative proposals in the paper to begin being implemented in 2022.
Building on proposals established in the NHS Long Term Plan, the whitepaper focuses on integrated care systems (ICSs), breaking down barriers to accessing health and social care separately, and building on lessons learned from the coronavirus pandemic, such as accelerated adoption of assistive technology.
Here are some of the key legislative proposals outlined in the new whitepaper:
NHS and local authorities have a duty to collaborate
Building on its ambitions of integrating care to support better patient outcomes, the whitepaper details two forms of integration which will be underpinned by the legislation.
They are: integration within the NHS to remove some of the boundaries to collaboration and to make working together an organising principle; and greater collaboration between the NHS and local government, as well as wider delivery partners, to deliver improved outcomes to health and wellbeing for local people.
Explaining this in further detail, DHSC says: “The NHS and local authorities will be given a duty to collaborate with each other. We will also bring forward measures for statutory integrated care systems (ICSs). These will be comprised of an ICS Health and Care Partnership, bringing together the NHS, local government and partners, and an ICS NHS Body.
“The ICS NHS body will be responsible for the day to day running of the ICS, while the ICS Health and Care Partnership will bring together systems to support integration and develop a plan to address the systems’ health, public health, and social care needs. Both bodies will need to draw on the experience and expertise of front-line staff across health and social care.”
Changes to procurement and commissioning
In moves to reduce bureaucracy, the whitepaper says that the NHS should be free to make decisions on how it organises itself without the involvement of the Competition and Markets Authority (CMA).
Significantly, the government details that procurement processes should only go ahead if they add value, moving away from the notion of procuring services that deliver the biggest cost-savings and rather focusing on improved patient outcomes.
CCG commissioning functions changes
Importantly, the government has concluded that the allocative functions of Clinical Commissioning Groups (CCGs) should be held by a system level body responsible for integrated care –an ICS NHS Body.
This will see the ICS NHS Body take on the commissioning functions of the CCGs and some of those of NHS England within its boundaries, as well as CCGs’ responsibilities in relation to Oversight and Scrutiny Committees.
The whitepaper says that the ICS NHS Body will be responsible for the day-to-day running of the ICS and NHS planning and allocation decisions. This includes: developing a plan to address the health needs of the system; setting out the strategic direction for the system; and explaining the plans for both capital and revenue spending for the NHS bodies in the system.
Government intervention powers
Furthermore, the document says it is bringing forward a proposal to ensure the Secretary of State for Health and Social Care has appropriate intervention powers with respect to relevant functions of NHS England.
According to DHSC, this will allow the Secretary of State to set clear direction, support system accountability and agility, and also enable the government to support NHS England to align its work effectively with wider priorities for health and social care.
In addition, the paper proposes that the Secretary of State will be allowed to intervene in local service reconfiguration changes, where required, to facilitate increased accountability.
Changes to social care
To help ensure that adult social care is delivering the right kind of care and the best outcomes for end-users, the document proposes to introduce, through the Health and Care Bill, a new duty for the Care Quality Commission (CQC) to assess local authorities’ delivery of their adult social care duties.
The paper adds that it wants to introduce a power for the Secretary of State to intervene where, following assessment under the new CQC duty, it is considered that a local authority is failing to meet their duties.
D2A model changes
Introduced in August 2020, the current discharge to assess (D2A) model focuses on discharging patients from hospitals into the appropriate setting, considering what care they might need after being discharged from hospital, whether that is care at home or going into a care home, for instance.
Now, the government is looking to bring forward measures to update approaches to this process to help facilitate smooth discharge, by putting in place a legal framework for a D2A model, whereby NHS continuing healthcare (CHC) and NHS Funded Nursing Care (FNC) assessments, and Care Act assessments, can take place after an individual has been discharged from acute care.
“This will replace the existing legal requirement for all assessments to take place prior to discharge,” the whitepaper states.