Blueprint for NHS and social care reform
The Health and Social Care Secretary has set out “new proposals to build on the NHS response to the pandemic”.
The proposals will bring health and care services closer together with the aim of improving care and tackling health inequalities through measures to address obesity, oral health and patient choice.
The Government says that the measures, set out in a white paper, are designed to 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.
It sets out to 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”, by bringing together the NHS, local government and partners together to tackle the needs of their communities as a whole.
The proposals build on the NHS’ recommendations for legislative change in the Long Term Plan and aim to 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.
A bill will be laid before Parliament later in the year.
Health and Social Care Secretary, Matt Hancock, commented: “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.”
Key measures include:
- The NHS and local government will 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.
- NHS staff currently waste a significant amount of time on unnecessary tendering processes for healthcare services. Under the 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 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 Healthcare Safety Investigations Branch 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.
Prof Helen Stokes-Lampard, chair 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.”
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. 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.
Responding to the Health and Care White Paper, chief executive of the Health Foundation, Dr. Jennifer Dixon, said: “One half of the proposals – to help local services collaborate better – could help improve care for patients and follows the direction NHS leaders are already taking. The other half – giving the Secretary of State more power over the NHS – is concerning, has no clear rationale and could take health care backwards.
“Proposals to boost collaboration between services are welcome and might bring real benefits, although these are often oversold to justify change. And there are risks – the NHS is currently facing the biggest challenge in its history. With a major backlog of unmet care needs and a workforce crisis to address in the wake of COVID-19, a reorganisation of the health system could cause distraction and disruption.
“The proposals for more 'command and control’ over the NHS by the Secretary of State are politically driven. The government’s handling of COVID-19 is no advert for more ministerial intervention in the health system. It is disappointing that political energy isn’t focused on fixing adult social care, one of the biggest policy failures in a generation, instead.”
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