Government whitepaper sets out important plans for integrating health and social care

Patients are set to receive better, more joined-up care according to new plans published by the Department of Health and Social Care (DHSC) to improve the links between health and social care by breaking down barriers, pooling budgets, and focusing on shared outcomes and accountability.

‘Joining up care for people, places and populations’ sets out a vision for an integrated NHS and adult social care sector that will better serve patients and staff.

Under the current system, patients often find themselves having to navigate complex and fragmented services. Patients frequently have to tell different people the same information across multiple organisations, while others can end up facing delayed discharge because the NHS and local authorities are working to different priorities in a way that is not as joined up as it could be, DHSC emphasises.

The new integration whitepaper aims to ensure that the health and social care services are joined up to make services more efficient, high quality and better value for money for staff, providers, and patients.

“Successful integration is the planning, commissioning and delivery of coordinated, joined up and seamless services to support people to live healthy, independent and dignified lives and which improves outcomes for the population as a whole,” DHSC says.

The integration whitepaper builds on both the Health and Social Care Bill and the People at the Heart of Care whitepaper, which set out a 10-year vision for social care funded through the Health and Care Levy, and follows the delivery plan for tackling the COVID-19 backlog of elective care.

Health and Social Care Secretary Sajid Javid said: “Better integration is vital to stop people falling into the gaps between health and social care. Ensuring our health and care systems work in unison will mean we can support hardworking staff, provide better care to patients and deliver value for the taxpayer.

“Our Integration whitepaper is part of our wider plans to reform and recover the health and social care system, ensuring everyone gets the treatment and care they need, when and where they need it.”

Overview of the key ambitions from the integration whitepaper

The whitepaper sets out some of the ways health and care systems will draw on the resources and skills across the NHS and local government to better meet the needs of communities, reduce waiting lists, and help level up healthcare across the country.

As an overview, this includes:

• Ensuring local authorities and the NHS share data and are more transparent about their performance so that local populations can make decisions about their own care
• Focusing on earlier intervention to prevent diseases from progressing and avoid expensive interventions
• More personalised care through linking GPs with wider forms of community support
• Giving patients a single digital care record so they can book appointments, order prescriptions, and communicate with their care providers on a single platform, while those involved in delivering health and care services can access the patient’s latest information. This avoids the issue of patients having to repeat themselves to different people, and it gives professionals the information they need to make care plans for the patient
• Improving access to social care services through NHS data sharing, which would allow the NHS to notify a local authority straight away if a person requires social care support
• Plans for better treatment by joining up primary, community and hospital services
• Better NHS support to care homes so that residents can be treated in a home and prevent unnecessary hospital trips
• Better coordinated services to prevent patients from having to coordinate between different professionals themselves
• Reducing duplication and waste so that NHS investment can be spent in ways that benefit patients and deliver savings for social care
• Aligning financial incentives and pooling budgets so that the NHS and local authorities can use their resources more flexibly to benefit patients

A closer look at the key proposals from the whitepaper

Below, AT Today has delved into some of the key proposals from the integration whitepaper in more detail.

The full whitepaper can be found here.

Setting shared outcomes

DHSC proposes a large focus on setting shared outcomes across health and social care as a way to bring organisations together with a common goal.

The government has set out the case for a new approach for designing and measuring progress against these. It will work with stakeholders to develop and introduce a framework with a focused set of national priorities, and an approach for prioritising shared outcomes at a local level, focused on individual and population health and wellbeing.

DHSC will also set out a framework that makes space for local leaders to agree shared outcomes that meet the particular needs of their communities, whilst also supporting national priorities.

Implementation of shared outcomes will begin from April 2023.

Leadership and accountability

The whitepaper emphasises that effective leadership, accountability and oversight are key to successful integration. DHSC is going to make changes that bring together local leaders to deliver on shared outcomes in an accountable and transparent manner, through formal place-based arrangements (“place” is a geographic area that is defined locally, but often covers around 250-500,000 people).

The document states: “We will set out criteria for place-level governance and accountability for the delivery of shared outcomes. We have suggested a model which meets those criteria and expect places to adopt either this specific governance model, or an equivalent, by Spring 2023.”

Local authority and NHS leaders will be responsible for delivering against the agreed outcomes and will be accountable for delivery and performance against them.

There should be a single person, accountable for shared outcomes in each place or local area, working with local partners, DHSC says. This person will be agreed by the relevant local authority or authorities and Integrated Care Board (ICB). The government expects place-based arrangements to align with existing integrated care system (ICS) boundaries as far as possible.

Finance

NHS and local government organisations will be encouraged to do more to align and pool budgets, the whitepaper highlights. This is both to ensure better use of resources to address immediate needs, but also to support long-term investment in population health and wellbeing.

The government states that it will work with partners to develop guidance for local authorities and the NHS to support going further and faster on financial alignment and pooling. It adds that it is looking to simplify the regulations for current pooled budget arrangements for commissioners and providers.

Digital capabilities

By 2024, the government aims to have shared care records for all citizens that provide a single, functional health and care record, which citizens, caregivers and care teams can all safely access. This is intended to reduce patients having to repeat the same information across a disjointed health and social care service.

There is also a big push towards formally recognising the power of digital services, as the whitepaper explains: “We will support digital transformation by formally recognising the Digital Data and Technology profession within the NHS Agenda for Change and including basic digital, data and technology skills in the training of all health and care staff.”