New White Paper aims to create a more integrated health and social care system

New structural reforms to integrate health and social care announced by the Government have been criticised for coming at a time when the NHS, local authorities and charities are still battling Covid-19.

The King’s Fund said that while there was much to welcome in the ambition of the White Paper – Integration and Innovation: working together to improve health and social care for all – it will be essential to avoid distracting health and care services from dealing with the crisis at hand.

Proposals for sweeping reorganisation on such a scale will need greater time for consideration, according to the BMA. It says they must not be rushed through while doctors are still tackling the winter surge in infections, hospitalisations and tragically, deaths.

Chaand Nagpaul, BMA council chair, said: “While the BMA supports greater collaboration within the NHS, our members and their colleagues need a real chance to assess these plans and their implications. On the back of a year in which doctors have gone above and beyond in responding to the greatest health crisis in a generation, they are now both physically and emotionally exhausted.

“The immediate and forthcoming challenge for the NHS will be addressing the greatest backlog of care our health service has ever faced, alongside the continued pressures of Covid-19. This requires significant new resources and an immediate action plan, rather than risk being diverted by a reorganisation of the health service in the midst of the pandemic.”

Health and Social Care reform proposals

This White paper sets out legislative proposals for a Health and Care Bill that aims to build on the collaborations seen throughout the Covid-19 pandemic.

The major reform will reverse the provisions in the Health and Social Care Act 2012. According to The Health and Social Care Secretary Matt Hancock, they 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, by bringing together the NHS, local government and partners together to tackle the needs of their communities as a whole.

The measures include proposals to make integrated care the default, reduce legal bureaucracy, and better support social care, public health and the NHS. The reforms will also aim to use technology to provide 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.

Removal of clunky competition and procurement rules

One of the key measures is that 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.

Chaand Nagpaul said that the BMA has campaigned since 2012 against wasteful and bureaucratic NHS procurement rules that require all contracts to be put out to competitive tender. While the White Paper proposes ending these competition rules, the BMA has previously expressed concerns that this could lead to awarding contracts without sufficient scrutiny to outsourced providers at huge expense to the taxpayer.

He added: “We have seen the devastating impact of this happening during the pandemic with both PPE and ‘NHS’ Test and Trace. In contrast, where the NHS and clinicians were given the chance to lead, as in the vaccine programme, we have achieved far better progress, demonstrating why the BMA believes that the NHS should always be the preferred provider for NHS services. This is an opportunity to roll back on the expensive and inefficient use of the private sector, not increase it.

“Since its inception the NHS has been subject to countless restructures, and the BMA will be interrogating these latest proposals in detail to ensure that they are informed by the expertise of doctors, and deliver real change that secures a better deal for staff and quality care for patients.”

Richard Murray, Chief Executive of The King’s Fund, said the welcome shift away from the old legislative focus on competition between health care organisations towards a new model of collaboration, partnership and integration was the most important element of the White Paper, and marks a decisive step away from the coalition government’s 2012 reforms.

He said: “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.”

He added though that the history of the NHS is littered with reform plans that overestimated benefits and underestimated disruption and 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.

Social care reform will be delayed until later this year

The government intends to bring forward separate proposals on social care reform later this year. But, the White Paper proposes a package of measures to deliver on specific needs in the social care sector.

The Government says 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.

However, GMB, the union for health and social care workers, has called on the Ministers to address the hole at the heart of the health and social care White Paper: the Government’s promises to fix social care.

Rehana Azam, GMB National Secretary, said:  “The Prime Minister promised 18 months ago to ‘fix’ social care within 12 months of being in government. We still have nothing from them other than a flimsy pledge to set out these reforms ‘this year’.

“For too long politicians have kicked social care into the long grass. The pandemic has vividly shown what that has meant for those getting care, their families and the workforce. We don’t need further reforms, we need a properly funded, publicly delivered National Health and Care Service – one that values the backbone of our health services, our staff.”

Legislation won’t make collaboration happen but it can remove barriers

Prof Helen Stokes-Lampard, Chair of the Academy of Medical Royal Colleges welcomed the central proposals to drive integration and support greater collaboration through integrated care systems (ICS), that go beyond the traditional NHS boundaries.

She added: “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.”