This article was co-authored by Amber Banerjee, Trainee Solicitor, Cambridge office.
Building on the NHS Five Year Forward View in October 2014 and the Long-Term Plan published in February 2019, the Department of Health and Social Care have published their latest proposals for a Health and Care Bill. The proposals are set out in a White Paper published on 11 February 2021, - ‘Integration and Innovation: working together to improve health and social care for all’, which can be found here.
Aims of the White Paper
By way of a summary the White Paper sets out the following aims:
- Working together to integrate health and social care - Connecting the public health and social care system in order to ensure ‘joined up care for everyone in England’
- Reducing bureaucracy - Removing barriers and granting the necessary flexibility to NHS organisations
- Improving accountability and enhancing public confidence
Integrated care systems
As part of its proposals to achieve greater integration, the White Paper proposes the introduction of statutory integrated care systems (ICSs) consisting of two bodies - an ICS NHS body and an ICS Health and Care Partnership.
- The ICS NHS body will be responsible for the day to day running of the ICS. This will involve allocating funds from NHS England for its population and developing plans to meet their clinical needs. It is this body which will take on the commissioning function currently fulfilled by clinical commissioning groups, which will be abolished under this new structure.
- The ICS Health and Care Partnership, will be responsible for developing wider systems to address the system’s health, public health and social care needs. The ICS NHS Body will be required to take these plans into account when making decisions.
It should be noted that the ICSs are not new to the management of the NHS. However, current systems are voluntary with no statutory basis and accordingly are a matter for the discretion of the bodies involved.
The expansion of this model hopes to build on the success of these voluntary partnerships. Part of this success is the flexibility to address the specific needs of different patient groups. For instance, the Surrey ICS (the Surrey Heartlands Health and Care Partnership) has specifically identified mental health, diabetes and cancer care as some of the key areas that would benefit from a more collaborative approach to healthcare.
The benefits to integrated care have been further shown in Cambridgeshire and Peterborough in the provision of mental health support. Their integrated service has reduced the use of the emergency department for mental healthcare by 20% and of patients being admitted to acute hospitals from the emergency department by 26% (see details of the case study on joined-up care available here).
In order to support this greater integration, the paper proposes a range of measures including a broad duty to collaborate.
The paper also sets out a ‘triple aim’ duty which shall apply to ICSs, NHS England and NHS Trusts, “to support better health and wellbeing for everyone, better quality of health services for all, and sustainable use of NHS resources.” A new statutory duty is proposed on NHS Trusts and Foundation Trusts to have regard to the system’s overall financial objectives.
This shift towards a more collaborative way of delivering healthcare has already been seen in the creation of the Primary Care Networks under the Long-Term Plan and this further step is welcome. The voluntary partnerships already in place do seem to point to better patient outcomes although we note the disquiet voiced by some GPs who fear a loss of autonomy.
However, questions of legal accountability remain. Under these proposals will NHS bodies find themselves facing not only liabilities for other healthcare bodies, but also local authorities and their undefined ‘wider partners’ if pathways fail to deliver. Some query whether ICSs are set up to fail if appropriate resourcing does not follow, particularly given the deficits in the social care budgets. Further, on the ground, the huge boost to collaborative working that we have seen with virtual multi-disciplinary team meetings for example is already transforming this space. Equal attention needs to be given to digital compatibility, secure data sharing and investment in digital tools and innovation to harness the expected gains.
The exact nature of the relationships within these statutory ICSs have yet to be seen, with the current systems in place up to the discretion of their members. The proposals notably avoid a one-size fits all approach and as such, we look forward with interest to the publication of the Health and Care Bill.