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Into Perspective: What does the Government’s White Paper proposals on integrated care promise?

On 11th February 2021, the Department of Health and Social Care published the White Paper Integration and innovation: working together to improve health and social care for all, which sets out legislative proposals for a health and care Bill.

Intro commentary by Helen McKenna of The King’s Fund

Dual structure

At the heart of the changes set out in this section is the proposal to establish integrated care systems (ICSs) as statutory bodies in all parts of England. ICSs will be made up of two parts – an ‘ICS NHS body’ and an ‘ICS health and care partnership’. The dual structure is a new development and recognises the two forms of integration that are needed to adopt a population health approach aimed at improving the health and wellbeing of local populations: integration within the NHS (between different NHS organisations) and integration between the NHS and local Government (and wider partners).

The ICS health and care partnership will be responsible for developing a plan to address the system’s health, public health and social care needs, which the ICS NHS body and local authorities will be required to ‘have regard to’ when making decisions. The membership of the partnership and its functions will not be set out in legislation – instead, local areas will be given the flexibility to appoint members (likely to be from the wider system – for example, Healthwatch, voluntary and independent sector providers, and social care providers).

The document also recognises the importance of ‘place’, which is a smaller footprint than that of an ICS, often that of a local authority. Experience suggests that much of the heavy lifting of integration and improving population health is driven by organisations collaborating at this level and successful ICSs have therefore often concentrated their efforts on developing the places within their footprint. The Department states that it has decided against giving place a statutory underpinning although it is explicit that there will be an expectation that ICS NHS bodies delegate ‘significantly’ to place level as well as to provider collaboratives. The development of place-based partnerships will therefore be left to local determination, building on existing arrangements where these work well. ICSs will be expected to work closely with health and wellbeing boards and required to ‘have regard to’ the joint strategic needs assessments and joint health and wellbeing strategies produced by health and wellbeing boards.

To read Helen’s commentary in full, visit The Kings Fund website.

What else was promised?

The Government said a new power for the Secretary of State to make payments directly to adult social care providers will remove a bureaucratic barrier to delivering support to the sector in exceptional circumstances. The DHSC also said it wants to increase accountability in the delivery of social care through an enhanced assurance framework examining the performance of local authorities and a new power to collect data from providers.

Data Integration

The White Paper outlines that the Government aims to build on improvements made by existing tools such as the capacity tracker mandated during the pandemic and an increased ability to gather data from social care providers (for both local authority and privately funded care) and that they will remedy gaps in available data to help the Government understand capacity and risk in the system.

Define the role of care providers
 

We believe consistent approaches within an extensive and varied marketplace of providers across the newly formed 29 integrated care systems need to be developed.

ICS formations will have the potential to create culture change, but these culture changes never happen without all the partners being involved in co-design. This is something which has been missing in
the proposal.

As well as partner organisations, it is imperative the social care workforce is placed on the same footing as its NHS colleagues. Furthermore, it is vital the voluntary sector and those who make frequent use of health and care and those who are frequently excluded from equal access to services are also included. Our recommendation would therefore be genuine co-production with all stakeholders to define the role of the care providers within the ICS and Accountable Care Organisation (ACO) structures.

These would include yet not be limited to:

  1. Clarity of knowledge around the commissioning and budgetary management processes for a mixed landscape with LA, NHS and private payer care service models.
  2. Providing essential workforce support to the 1.6m social care colleagues with trusted partners such as Skills for Care.
  3. Developing the ICS shared agenda for system improvement, enabling people accessing care to have choice and outcomes to live their best lives. Enabling improved wellbeing from social care services as well as better health outcomes.
  4. Finding a path through the centre of national and local decision making with expert- led negotiation.
  5. Considering the practicalities of how key performance indicators will work within the varied health economies for the ICS and ACO structures.
  6. Sharing the best practice stories that inspire the process and online shared learning spaces.
  7. Developing and recreating quality-led services that will drive innovation in practice.

Kathy Roberts, Chair of the Care Provider Alliance

We need to foster a culture change
 

 The Government’s recently published Health and Care White Paper heralded an aspiration for closer integration between health and social care.

This, of course, was one of the aims of the 2012 reforms so it feels like we have been here before and, in practice many areas including here in Somerset have undertaken closer working between councils and the wider health ecosystem. But further enablers are welcome and an aim to create a system of localised health and care that is as seamless as possible should certainly be lauded.

So far so good, then: with the White Paper laying out a positive direction of travel. Proposals to align Integrated Care Systems with upper-tier local authority boundaries will hugely assist in the integration of health and care closer to communities – and this was something the County Councils Network (CCN) had been arguing for.

However, answering the question on what closer integration, as per the White Paper, looks like in practice is difficult with two major agendas still up in the air. The first is whether social care and the health service truly achieve parity of esteem. Many were disappointed that the long-trailed proposals for social care this Government has promised have still yet to see the light of day, despite health reforms being published. It is imperative that the care Green Paper is released as soon as possible so both sets of reforms can be implemented in tandem.

Secondly, social care must remain locally delivered by councils. This was emphatically argued in a recent report by care specialists Newton Europe for the CCN. They set out an inspiring blueprint for reformed care locally – with local health, care providers, and councils all stepping up to work more closely and effectively: putting the individual first.

We can’t simply magic up closer integration. We need the resources to drive reform, but we also need to foster a culture change with practitioners, providers and councils working more collaboratively. Closer integration is what we are all aspiring towards – let’s keep care local and build on the solid foundations we have in place rather than ripping them up.

Cllr David Fothergill, Health and Social Care Spokesperson for the County Councils Network

 

Kathy Roberts

About Kathy Roberts

Kathy Roberts is the Chief Executive of Association of Mental Health Providers, the only national representative organisation for voluntary and community sector mental health service providers and was…

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also the Chair of the Advocacy Topic Group for the Independent Review of the Mental Health Act.

David Fothergill

About David Fothergill

Cllr David Fothergill is a Health and Social Care Spokesperson for the County Councils Network. David has a wide range of operational experience including manufacturing, Children’s Homes and Older P…

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eople care. Most recently, he has been Director of HR for a large South West employer operating across 43 sites. Before becoming Leader of the County Council in May 2017, David served two years as Cha irman of and a further two years as Cabinet Member.

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