The Government has passed the long-awaited new Health and Care Act, marking an important milestone for the long-term recovery of services.
The Health and Care Act 2022 comes 10 years after the last major legislative reform of the NHS across England.
The new laws will increase funding, remove existing competition rules, and formalise the creation of Integrated Care Systems (ICSs) to commission local services.
The record levels of funding, in tandem with the incoming structural changes like statutory ICSs, creates an environment that is ripe for innovation, enabling us to tackle the biggest healthcare challenges
The document also grants the Health Secretary authority over the health service moving forward.
What does it mean for the NHS?
Establishing ICSs as statutory bodies
This move makes the previously-informal roles of ICSs formal, to help ensure they can be held accountable and empower them to govern NHS finances at a local level.
Specifically, the two component parts of an ICS – the Integrated Care Board (ICB) and the Integrated Care Partnership (ICP) – will now have statutory status and will collectively hold the legal powers and responsibilities.
ICBs will be responsible for the NHS functions of an ICS, while ICPs will oversee their wider public and population health efforts.
Transfer duties for commissioning services to ICSs
This means that clinical commissioning groups (CCGs) will be absorbed into their local ICSs.
Their commissioning powers, and the majority of their staff, will then become part of the ICS body.
These powers will sit within the ICB, which will manage NHS commissioning and funding.
Stop automatic tendering of NHS services
This will stop enforced competition, which has led to disruptive bureaucracy and fragmentation of services.
It will repeal Section 75 of the Health and Social Care Act 2012 and replace it with a new system – the Provider Selection Regime – which will give NHS bodies a wider range of options when commissioning services.
Support integration
The Act aims to support the development of ICSs and integration by requiring all health bodies to abide by a triple aim, to co-operatively pursue better care for all patients, better health and wellbeing for everyone, and sustainable use of NHS resources.
Expand the powers of the Secretary of State for Health
They will have increased power to direct the NHS, create new NHS trusts, intervene in local service reconfiguration, and amend or abolish arm’s length bodies.
Give the Secretary of State workforce reporting duty
There will be a new duty for the Secretary of State to publish a report at least once every five years on workforce planning. This would describe the system in place to for assessing and meeting workforce needs.
Introduce a cap on the cost of social care
The Act will introduce a new £86,000 cap on the amount anyone in England will need to spend on their personal care over their lifetime.
Only personal contributions to the cost of care will count towards the cap. Means-tested payments made by the local authority will not be counted.
Commenting on the passing of the Bill, Richard Murray, chief executive of the health think tank, The King’s Fund, said: “The day-to-day pressures of dealing with recovery from the COVID-19 pandemic, recurrent staff shortages, rising demand, and tight budgets are enough to keep everyone busy.
“This remains true despite the reforms holding out the opportunity of a more-integrated system that can provide longer-term focus on improving population health and reducing inequalities.
“It’s an opportunity that leaves much discretion to local leaders, rather than imposing a rigid one-size-fits-all solution that suits no-one.
The lack of ambitions in the Health and Social Care Bill on digital transformation is incredibly disappointing and potentially damaging to the future of the healthcare service
“But this is just an opportunity and whether it is realised into actual benefits relies on the changes in practice and cultures that underpin a more-collaborative, integrated system.”
Chris Hopson, chief executive of NHS Providers, added: “We welcome the publication of this Bill, which will help provide clarity for trusts in a fast-changing health and care landscape.
“Trusts have been at the forefront of the move towards closer collaboration and integration between health and care, a process that has accelerated in recent months to deal with the extraordinary pressures of the pandemic.
“The legislation will formalise this process, so trusts and their partners can plan and cooperate more closely to help build healthier communities.”
But critics have spoken out about the lack of focus on the role technology can play in the new landscape.
Speaking to BBH, Dr Rachael Grimaldi, co-founder and chief executive of digital communications company, CardMedic, said: “The record levels of funding, in tandem with the incoming structural changes like statutory ICSs, creates an environment that is ripe for innovation, enabling us to tackle the biggest healthcare challenges.
“A major reason for inequitable access to health and care services is additional communication needs, which affect more than 35% of people.
If digital transformation isn’t a core value within Integrated Care Systems then there is a huge risk opportunities will be missed to create a sustainable health system that is fit for the future
“Such inequity is unacceptable and is something that can be easily rectified by the use of digital tools.
“Therefore, the lack of reference to digital and its applications in this landmark legislation is disheartening.”
Tom Whicher, chief executive of DrDoctor, adds: “Seeing progress being made towards a fully-integrated and streamlined healthcare system is, of course, a major step forward for patient care.
“However, the lack of ambitions in the Health and Social Care Bill on digital transformation is incredibly disappointing and potentially damaging to the future of the healthcare service.
“A key component of the legislation is the recovery of the elective backlog, which is vital to make sure patients receive safe and high-quality care.
“However, it doesn’t recognise the importance of good digital tools in achieving this ambition.
“By digitising patient-initiated follow-ups at NHS trusts, we help give patients control over their care by allowing them to choose when they attend a follow-up appointment, while freeing up staff time and appointments for patients who need them most. This has allowed hospitals to make major progress towards tackling their elective backlogs built up over the pandemic.
“If digital transformation isn’t a core value within Integrated Care Systems then there is a huge risk opportunities will be missed to create a sustainable health system that is fit for the future.”