Health and Care Bill: Policy Briefing
Integrated Care Systems
Integrated Care Systems (ICS) will be put on a statutory footing and will be made up of an integrated care board (ICB) and an integrated care partnership (ICP). ICBs, which will also be statutory bodies, will take up the day-to-day running of the NHS with ICP-formulated integrated care strategies to ensure the system’s health needs are met. As a result, CCGs will be scrapped.
Integration is to be put at the heart of this system. Chiefly, the legislation will set out the NHS’s need to work together across NHS organisations and provide greater integration across the NHS, local bodies, and other partners – with patient input being a primary focus in all aspects.
The ICB and relevant local authorities will be mandated to establish an ICP, which will bring together many different partners and stakeholders across the health and social care spectrum. It is hoped this will provide a more joined-up, local approach to health and patient wellbeing in England. Key to ICS policy is commissioners and providers working within smaller geographies in ICSs (‘places’) and teams delivering services on an even smaller level (‘neighbourhoods’) as a means of improving integration and local population health.
As ICSs are already well-established in some areas, some have a head-start on others. Due to the much more familial, cooperative system, prospective ICSs can look to Frimley and Surrey Heartlands currently as the ideal ‘model’. However, it must be remembered that this project is merely in its early stages. Therefore, it can be expected ICS models to evolve as the systems develop, particularly as there is no one-size-fits-all approach due to each area’s unique requirements.
BIVDA wholly supports the ambitions of ICSs in bringing care closer to patients and believe that this will result in a better quality of service to those managing long-term health conditions. This joined-up approach, twinned with better local access for patients, has the potential to be a game-changing development in the pursuit of identifying and treating diseases more efficiently. This is a particularly welcome prospect amidst the backlog and the difficulty patients have faced in accessing services over the course of the pandemic.
Integrated Care Boards
Being put on a statutory footing will give ICBs decision-making powers as well as responsibility for NHS system performance, sustainability, and delivery. Moreover, it will hand NHS England the power to set a financial allocation or other financial objectives at a system level.
ICBs will be tasked with the day-to-day running of the NHS and must develop strategic plans and allocation decisions, including how to meet the health needs of those in their local area. ICBs will also develop a five-year forward plan which must be updated annually. System financial objectives are required to be met and financial balance will be prioritised, as Boards will be directly accountable for spend and performance. They will also take on the commissioning functions of clinical commissioning within their localities. The makeup of each ICB will include a chair, chief executive, local NHS representatives from different disciplines, and a local authority representative.
Integrated Care Partnerships
The primary role of ICPs will be to establish an integrated care plan which each ICB and local health authority must follow. This plan will tackle the health, social needs, and public health requirements in each individual system through local partnerships. Examples of membership of ICPs include: the voluntary and community sector, social care and housing providers, and representatives of Health and Wellbeing Boards.
A New Model: Collaboration, not Competition
Enshrined in the Bill is a duty to collaborate on both the ICB and local government. NHS bodies are also required to achieve the triple aims of the Long Term Plan: better health and wellbeing, better quality healthcare and ensuring the financial sustainability of the NHS.
Collaborative commissioning between NHS England and ICBs is supported by a range of provisions to find different ways of commissioning services, with the aim of improved health decisions at a local level. There is also a reduction in compulsory competitive procurement, which further signals the move towards collaboration rather than competition. Data sharing across health and care is strengthened significantly, for example, and there will be a requirement to share anonymised information for the benefit of the health and care system.
Automatic tendering of NHS services will be prohibited by the Bill to stop overly bureaucratic, enforced competition. Competition will, of course, still be allowed, but that decision is at the discretion of commissioners, who are expected to act in the best interests of the local population. As such, section 75 of the 2012 Health and Social Care Act will be repealed. This means that the restrictive regulations, which applied to services and not goods, have been removed to allow greater freedom for providers seeking to tender services to and for patients. Moreover, NHS trust will no longer be blocked from merging by the Competitions and Market Authority. These changes will provide a more efficient service and further bolsters the collaborative elements of the Bill. The removal of commissioner-led tendering, regarding pathology services for example, is most certainly a positive step and will hopefully eradicate disruptions and inefficiencies that have affected services in the past.
Secretary of State Powers
The Bill gives the Secretary of State powers to intervene in certain aspects of NHS management if they see fit, giving them significant power to reconfigure local services at any stage. However, this will only apply to “notifiable” changes, as opposed to extensive meddling. It also gives them the ability to direct NHS England beyond the objectives set out in the Government’s NHS Mandate. NHS leaders are also compelled to advise the health secretary of any significant reconfiguration of services, which they are permitted to either change or suggest alternative action. If the Secretary of State were to become involved in directing local reconfigurations, they would be time-limited to six months and be forced to publicly justify their decision. Relevant local organisations will also be asked for their opinions on the proposed changes and their responses will be published.
To some this may provide a reassuring final oversight, but to most analysts these powers appear at odds with the inherent localism of the ICS project and is instead a jarring power grab for Westminster. The final proposals appear to mitigate the worst effects of wide-ranging intervention powers, which would have the potential to undermine the most revolutionary aspects of ICSs. The watering-down of these powers ensure that the NHS is mostly protected from micro-management at the very top of Government.
At the latest stage, the Government have successfully inserted an amendment which aims to tackle modern slavery in supply chains. This has been raised, in part, due to concerns surrounding the use of slavery in the manufacturing of products in Xinjiang, China. This will aid the NHS in identifying products which are tainted by the evil of modern slavery through tough regulations, which will establish the likely risk of individual suppliers profiting from slavery and the basis on which they are excluded from the tendering process.
Amendments aiming to improve workforce planning by forcing the Government to publish regular workforce projections have failed. Instead, the Government have committed to producing a workforce report every five years at a minimum only. This is in addition to the review undertaken by Health Education England into the long-term strategic workforce trends in the NHS over the next 15 years, the results of which can be expected in the coming weeks.
Ensuring that the NHS has sufficient staff to meet the country’s needs, particularly with an increase in workload due to the backlog, is of primary importance. For our industry, it is paramount that the Government has a plan to guarantee that the UK has enough pathologists to fulfil its diagnostic ambitions amid huge testing commitments. Investments in diagnostic capacity, including staff, provide significant savings long-term and we hope the Government is mindful of this when developing its workforce strategy going forward. Workforce reporting of greater frequency would undoubtedly have strengthened the ability to cultivate said strategy, and it is a source of disappointment that adequate concessions were not made. The diagnostic hubs, for example, are a welcome addition, however, if not properly staffed then their benefits will be rendered redundant.
Social Care Costs
The Government have announced a £86,000 cap on social care costs from October 2023 and, through the introduction of the Health and Social Care Levy, have improved means-tested support for care costs. Only personal financial contributions will count towards the cap. This is a highly controversial element, as critics say that this will disproportionately affect the poorest in society. The Government have argued that the current model is financially unsustainable on the public purse meaning changes are essential.