Government announces blueprint for NHS and social care reform

New proposals launched to join up health and care services and embed lessons learned from the coronavirus pandemic

The Government has announced plans for new legislation to unite health and social services and tackle health inequalities

  • Action will support recovery by stripping away unnecessary legislative bureaucracy, empowering local leaders and services, and tackling health inequalities
  • The reforms build on the NHS Long Term Plan proposals and a bill will be laid in Parliament when parliamentary time allows to carry the proposals into law

The Health and Social Care Secretary, Matt Hancock, has set out new proposals to build on the successful NHS response to the COVID-19 pandemic.

The proposals will bring health and care services closer together to ‘build back better’ by improving care and tackling health inequalities through measures to address obesity, oral health, and patient choice.

The measures set out in a white paper to be published on the government website will modernise the legal framework to make the health and care system fit for the future and put in place targeted improvements for the delivery of public health and social care services.

It will support local health and care systems to deliver higher-quality care to their communities, in a way that is less legally bureaucratic, more accountable, and more joined up; bringing together the NHS, local government and other partners to tackle the needs of their communities as a whole.

The proposals build on the NHS’s recommendations for legislative change in the NHS Long Term Plan and come a decade on from the last major piece of health and care legislation.

While the NHS has made practical adaptations within the current legal framework, this can be unnecessarily time consuming and changes are now necessary as part of the future recovery process from the pandemic.

The measures include proposals to make integrated care the default, reduce legal bureaucracy, and better support social care, public health and the NHS.

And the reforms will enable the health and care sector to use technology in a modern way, establishing it as a better platform to support staff and patient care, for example by improving the quality and availability of data across the health and care sector to enable systems to plan for the future care of their communities.

These changes will allow us to build back better and bottle the innovation and ingenuity of our brilliant staff during the pandemic

Hancock said: “The NHS and local government have long been calling for better integration and less-burdensome bureaucracy, and this virus has made clear the time for change is now.

“These changes will allow us to build back better and bottle the innovation and ingenuity of our brilliant staff during the pandemic, where progress was made despite the legal framework, rather than because of it.

“The proposals build on what the NHS has called for and will become the foundations for a health and care system which is more integrated, more innovative and responsive, and more ready to respond to the challenges of tomorrow, from health inequalities to our ageing population.

“By acting now, the Government can make permanent some of the beneficial changes where COVID-19 has catalysed new and better ways of working and clear the path for improvements into the next decade, such as delivering on manifesto commitments including 50,000 more nurses and 40 new hospitals.”

Sir Simon Stevens, chief executive of the NHS, added: “Our legislative proposals go with the grain of what patients and staff across the health service all want to see – more joined-up care, less legal bureaucracy, and a sharper focus on prevention, inequality, and social care.

“This legislation builds on the past seven years of practical experience and experimentation across the health service and the flexible ‘can-do’ spirit NHS staff have shown in spades throughout the pandemic.

The NHS and local government have long been calling for better integration and less-burdensome bureaucracy, and this virus has made clear the time for change is now

“The proposals are designed to be flexible, allowing the health and care system to continue to evolve, and are designed to better equip the NHS and local health services to meet the longer-term health and societal challenges over the coming decades.”

The biggest change to legislation since 2012, the white paper will reduce some of the bureaucracy which currently cripples the system. Image by PublicDomainPictures

Key measures included in the Integration and Innovation: working together to improve health and social care for all white paper include:

  • The NHS and local government to come together legally as part of integrated care systems to plan health and care services around their patients’ needs and quickly implement innovative solutions to problems which would normally take years to fix, including moving services out of hospitals and into the community, focusing on preventative healthcare
  • Hardworking NHS staff currently waste a significant amount of time on unnecessary tendering processes for healthcare services. Under the new proposals, the NHS will only need to tender services when it has the potential to lead to better outcomes for patients. This will mean staff can spend more time on patients and providing care, and local NHS services will have more power to act in the best interests of their communities
  • The safety of patients is at the heart of NHS services. The upcoming bill will put the Healthcare Safety Investigations Branch permanently into law as a statutory body so it can continue to reduce risk and improve safety. The organisation already investigates when things go wrong without blaming people, so that mistakes can be learned from, and this strengthens its legal footing
  • A package of measures to deliver on specific needs in the social care sector. This will improve oversight and accountability in the delivery of services through new assurance and data sharing measures in social care, update the legal framework to enable person-centred models of hospital discharge, and introduce improved powers for the Secretary of State to directly make payments to adult social care providers where required
  • The pandemic has shown the impact of inequalities on public health outcomes and the need for government to act to help level up health across the country. Legislation will help to support the introduction of new requirements about calorie labelling on food and drink packaging and the advertising of junk food before the 9pm watershed

Professor Helen Stokes-Lampard, chairman of the Academy of Medical Royal Colleges, said: “We welcome the central proposals to drive integration and support greater collaboration through integrated care systems (ICS) that go beyond the traditional NHS boundaries. This is absolutely the right direction of travel for health and care more widely.

“Legislation won’t make collaboration happen, but it can remove barriers and facilitate the changes that the NHS really needs as we move into the post-pandemic recovery stage.

“It is vital that we see genuine clinical engagement at every level of the operation of the ICS to drive collaboration.

“We will look forward to reviewing the full range of proposals and engaging in the development of the legislation.”

The legislation will fold Monitor and the NHS Trust Development Authority into NHS England, while maintaining the clinical and day-to-day operational independence of the NHS.

And corresponding reforms will ensure the Secretary of State for Health and Social Care has the right levers to ensure accountability back to Parliament and taxpayers.

The white paper sets out the Government’s proposals for legislation, building on the extensive consultation that has already been undertaken by NHS England; and a bill will be laid before Parliament later in the year.

The Government also intends to bring forward separate proposals on social care reform later this year.

Legislation won’t make collaboration happen, but it can remove barriers and facilitate the changes that the NHS really needs as we move into the post-pandemic recovery stage

Commenting on the announcement, Ed Garratt, executive lead for the Suffolk and North East Essex Integrated Care System, said: “I welcome the white paper, as the lead of an integrated care system, as it gives clearer accountability for the NHS and, at a system level, formalises shared governance across the NHS, local government and other partners.

“The proposals will support greater collective effort on improving outcomes for our population, which is the ultimate purpose of our work.”

Richard Murray, chief executive of The King’s Fund health think tank, described the white paper as ‘a decisive step away from the coalition Government’s 2012 reforms’, but warned that the ‘NHS is littered with reform plans that overestimated benefits and underestimated disruption’.

He said: “Most important is the welcome shift away from the old legislative focus on competition between health care organisations towards a new model of collaboration, partnership and integration.

“By sweeping away clunky competition and procurement rules, these new plans could give the NHS and its partners greater flexibility to deliver joined-up care to the increasing numbers of people who rely on multiple different services.”

But he highlighted a potential issue with the proposal to give ministers the power to intervene earlier in local decisions about the opening and closing of NHS services.

“The Government and national NHS leaders should be looking to step away from the damaging model of top-down command and control in the NHS,” he said.

“The independence given to NHS England is seen as one of the successes of past reforms, and while it is right to clarify who is accountable for the health service, the Government should protect the day-to-day clinical and operational independence of the NHS.”

The Government and national NHS leaders should be looking to step away from the damaging model of top-down command and control in the NHS

And he concluded: “These latest proposals add up to a major reform package and come at a time when the NHS, local authorities and charities are still battling COVID-19.

“In implementing these proposals, it will be essential to avoid distracting health and care services from dealing with the crisis at hand.

“Health and care services are facing chronic staff shortages, deep health inequalities laid bare by the pandemic, and an urgent need for long-term reform of social care. In addition to the structural reforms proposed, there is a pressing need for the Government to chart a way out of these deep-seated challenges.”

And, speaking to BBH this week, Nick Sanderson, chief executive of care provider, Audley Group, said the joined-up health and social care plans did not go far enough.

“The UK’s fast-growing older population deserves better,” he adds.

“Yet again, the focus is on solving a problem already created, rather than preventing the problem from occurring in the first place.

“The focus could, and should, have been on limiting the need for these services altogether, and numerous studies have shown us that housing is the answer.

“Enabling the provision of more-appropriate housing for older people, with care and wellbeing services attached, changes the focus entirely to keeping people healthy and secure in their own homes rather than needing hospital or residential care.

“If this government wants to leave a legacy to be proud of, that genuinely rips apart a broken system and builds it back better from the ground up, then housing policy MUST be joined up with health and social care.”

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