The government’s new Health White Paper published on 11 February 2021 (Integration and Innovation: working together to improve health and social care for all) is an ambitious roadmap for significant reform, which comes at one of the most challenging times in the history of our health and social care system.
Now recognised as a critical part of the government’s Covid-19 recovery plan, fundamental to the reform is the commitment to: removing barriers to integration; tackling transactional bureaucracy; and implementing an accountable and responsive system.
Whilst setting out sweeping reforms and building on work already underway in the NHS’s Long Term Plan, the White Paper recognises the wider footprint of reforms in social care, public health and mental health. Further detail of these reforms will follow later this year and these are key interfaces for local government’s role in a truly joined up system.
This is certainly a welcome step towards giving local government a meaningful seat at the table of a place-driven strategy to care. The White Paper is just the start of the formal process with the Health & Social Care Bill being introduced to Parliament in the coming months with the implementation progressing into 2022.
Overhaul of the statutory framework: the statutory Integrated Care Systems
Sustainable and Transformation Partnership have been evolving into varying forms of integrated care systems at a regional level as part of the NHS Long Term Plan. The White Paper proposes to a statutory framework for these systems to establish:
- the ICS health and Social Care Partnerships, which will comprise of local authority, providers and other wider partner input to create the mechanism for supporting integration across health and social care;
- alongside the implied replacement of the Clinical Commissioning Groups (the paper does not explicitly reference these as being abolished), the new ICS NHS Body that will drive the integration agenda within the NHS and be responsible for the day to day to operation of the ICS.
Collaboration is at the centre of the proposals and indeed there is a specific statutory obligation to collaborate being set out for NHS bodies (ICSs and providers) as well as local authorities, which replace the two existing duties to cooperate introduced by previous reforms.
Local government will be particularly interested in how this ICS system of collaboration will facilitate a partner wide approach to driving transformation.
There are other welcomed statutory amendments including the role of the legal basis of the Better Care Fund, established since 2013 and an example of success of strategically driven integration, as well as much needed reform of data sharing systems amongst others.
Driven by Place?
The Paper’s Triple Aim of better health and wellbeing for everyone, better quality health services for all individuals, and sustainable use of NHS resources is to be supported by a commitment to place and strong community engagement.
Building therefore, on the NHS Long Term Plan, an ICS will be established across each part of the country. Interesting to review from a local government perspective is how the detailed proposals will be developed and the level of autonomy to develop local solutions for integrated working at ‘place’ level. The importance of ‘place’ in driving needs based systems is critical. Extending the concept of the ‘One Stop Shop’, this has potential to drive a sophisticated approach commissioning and provision.
Key questions will need to be addressed in due course around the practical alignment with local authority boundaries and the interface with health and wellbeing boards in particular.
Public Health and Social Care
The White paper acknowledges the key role of public health (introducing a statutory intervention regime for NHS England in respect of public health functions, obesity and water fluoridation) and pressures facing social care which require wider system reform (and does include welcome changes in the direct payment regime for providers).
It is widely recognised that the Covid-19 pandemic has exacerbated health and social care inequalities across all age and socio-economic groups. The pandemic has also highlighted the critical work of local government in addressing and tackling such inequalities and supporting communities.
Key to the new statutory framework for local government will be the wider reform of the social care and public health systems that will sit alongside the reform of the NHS and collaboration driven by this White Paper.
So, what should local government be doing now? As always, the challenge will be finding time and resources to devote to participating in the engagement process with relevant stakeholders. The proposals offer a chance to review local ambitions and take stock of the current relationship with local partners and development opportunities, as well as show case leading examples of innovation at a local level.
The coming months as the White Paper progresses through parliament are a critical time for the reform agenda and the key interfaces for local government.
Replicated with consent of Local Government Lawyer