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Published 12 February 2021
On 11 February 2021, the Department of Health and Social Care (DHSC) published its legislative proposals for a new Health and Care Bill, “Integration and Innovation: working together to improve health and social care for all ” (the White Paper). The plan is to implement these proposals in 2022.
There are three key messages in the proposals: working together to integrate care; reducing bureaucracy; and improving accountability and enhancing public confidence. The changes will help support the ‘triple aim’ of supporting better health and wellbeing for everyone, better quality of health services and sustainable use of NHS resources.
Our team at DAC Beachcroft have digested the White Paper and set out our top 10 takeaways:
1. Integrated Care Systems (ICSs) will become statutory organisations and will be responsible for strategic commissioning. An ICS will comprise (a) an ICS Health and Care Partnership which will bring together parts of the system, including local authorities, primary care, independent sector and voluntary sector; and (b) an ICS NHS Body which will be responsible for the day-to-day running of the ICS. There will be flexibility for the ICS as to how it is structured – this will not be a top-down re-organisation. ICSs will merge the functions of CCGs alongside some existing NHS England functions and new strategic functions.
2. An ICS will be set a financial allocation by NHS England. The ICS NHS Body will develop a plan to meet the health needs of its population and develop a capital plan for the NHS providers in its geography. The ICS NHS Body Chief Executive will become the Accounting Officer for the NHS money allocated to the ICS.
3. Most services will be designed and delivered at Place level. Places will generally be aligned geographically with local authority boundaries and there must be joint decision-making with local authorities. Places are not legal entities. This is where providers of primary care, community and mental health, social care, and urgent and emergency care will work together. The Better Care Fund plan will provide a tool for agreeing priorities. Place leaders will be represented at ICS level.
4. There will be a duty to collaborate. NHS providers will be told to work together in provider collaboratives and organisations across the health and care sector will have a duty to collaborate. The legislation will be amended to assist organisations by enabling decisions to be taken by joint committees without the need for unanimity.
5. There will be reduced bureaucracy across the system to remove transactional barriers to collaborative working. The NHS will be able to organise itself without the involvement of the Competition and Markets Authority. Health services will be carved out of the Public Contracts Regulations 2015 and the NHS (Procurement, Patient Choice and Competition) (No 2) Regulations 2013 will be repealed. This will be replaced with a bespoke health services provider selection regime, currently being consulted upon.
6. Population health is at the heart of these proposals. Provider collaboratives will have outcomes-based contracts which look at the health of the population at place or ICS level. Changes to the National Tariff will enable it to work more flexibly with population health contracts, rather than focussing on activity-led inputs. Patient choice is still important and NHS bodies will be required to protect this.
7. The government will have the power to impose capital spending limits on Foundation Trusts, as it currently does on NHS Trusts. The government will have the power to set legally-binding Capital Departmental Expenditure Limits (CDEL) for individual, named Foundation Trusts which are not working to prioritise capital expenditure within their ICS.
8. NHS England will formally merge with NHS Improvement and be designated NHS England. The merged entity will be accountable to the Secretary of State, while maintaining operational independence.
9. There will be changes to social care and public health changes including ensuring better integration with the NHS through the ICS structure. A new legal power to enable the Secretary of State to make direct emergency payments to social care providers has been proposed, alongside an enhanced framework and improved data collection to improve accountability in the social care sector. The government will have functions concerning public health including new powers to oversee fluoridation of water in England, to increase restrictions on advertising of unhealthy food and to alter food labelling requirements.
10. Patient Safety and regulatory change. Using the new Health and Care Bill to re-position the existing Health Services Safety Investigations Body (HSSIB) as statutory body, with the notable extension of HSSIB investigative reach to include treatment provided by the independent sector, in addition to changes around the concept of ‘safe space’ in those investigations. The same Bill will propose establishment in statute for the current Medical Examiners scheme, and restructuring of the regulation of healthcare professionals, by reducing the number of professional bodies. Further regulatory change in landscape will enable the Medicines and Healthcare products Regulatory Agency (MHRA) to set a national medicines registries; and legislation will be put in place to enable the implementation of comprehensive reciprocal healthcare agreements with other countries.
Should you wish to discuss the impact of the White Paper please do contact our health and social care law experts.
We have recently published a new series of podcasts on the NHS White Paper, called 'White Paper, White Light'. Episode one focuses on the importance of 'place' and gathers insight from senior leaders in the NHS, including the Chair of our podcast, Mike Bell (Chair of Croydon Health Services in South London and Chair of Barking, Havering and Redbridge University Hospitals in North East London).
This second episode from the White Paper, White Light podcast series, examines the importance of Provider Collaboratives in helping to deliver office efficiencies and drive service transformation.
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