Lack of social care plans risk hampering integration reforms

Publishing its report on the government’s integrated care white paper, Integration and Innovation: working together to improve health and social care, the committee said social care was a ‘glaring omission’ from the white paper. In the Queen’s speech this week the government said it would bring forward a bill to put the white paper proposals into law in a health and care bill.

Generally, the committee backed the white paper’s approach. Committee chair Jeremy Hunt (pictured) said: ‘We broadly support the proposed changes provided the new ICSs are held accountable for the quality and safety of care delivered through transparent CQC assessments. But we remain concerned about glaring omissions, including the lack of social care reform, and a much-needed overhaul of workforce planning.

‘If such issues are addressed the government has an opportunity to deliver a post-pandemic watershed “1948 moment” for the health and care system, matching the significance of the year the NHS was founded. But if they are not, it will be a wasted opportunity to deliver the truly integrated care required by an ageing population.’

The committee was also concerned that the white paper did not set out a long-term plan for social care – the absence of a costed plan could destabilise ICSs, it said. It noted the prime minister’s promise to bring forward a 10-year plan later this year and said the bill should include a requirement for the health and social care secretary to produce the plan and detailed costings within six months of the bill receiving royal assent.

The white paper's plan to produce an update of roles and responsibilities every five years is an inadequate response to endemic workforce shortages, the committee said. The bill should include a requirement for Health Education England to produce ‘objective, transparent and independent’ annual reports on workforce shortages in health and social care, and projections on staffing requirements.  

‘We are supportive of the report’s strong recommendation on workforce planning,’ said NHS Confederation chief executive Danny Mortimer. ‘The NHS Confederation believes the white paper does not go far enough in addressing the scale of workforce shortages and has written to the government to ask for accountability and responsibility to reside with the secretary of state.’

The health and care committee welcomed the health secretary’s confirmation that a patient’s right to choose where they are treated will be retained, along with plans to allow the Care Quality Commission to rate ICSs. The ratings should include a consultation with patient groups, consideration of patient outcomes, and progress on the integration of information technology between primary care, secondary care and the social care sector.

The committee also called for the government to be flexible in its ICS implementation timetable, given the effect of the Covid pandemic on health services and the fact that some systems will be further on the road to integration than others. To ensure all areas benefit, it urged the Department of Health and Social Care and NHS England to ensure best practice is shared quickly and effectively and ICSs with low CQC ratings are supported.

Local leaders should have a role in setting the pace of implementation, to ensure their area’s response to Covid-19 or recovery plans are not affected.

NHS Providers chief executive Chris Hopson (pictured) said local areas needed this flexibility. “We back the recommendation for giving the NHS flexibility in the timeframe for implementing what is likely to be the biggest reforms in nearly a decade at a time when the service is also grappling with an unprecedented care backlog. With the latest data showing nearly 5 million people on the waiting list for planned care and 436,000 people waiting longer than a year for surgery, we must enable the NHS to concentrate on patient care rather than being distracted by structural reform,’ he said.

The ICS NHS body and health and care partnerships, which will both be statutory bodies, need clear lines of accountability, the health committee said. A more detailed framework of roles and responsibilities should be set out in the bill. And NHS England should issue guidance on how the duties of trusts fit in with these, to avoid confusion, duplication or overlap.

In its submission to the health and care committee’s inquiry into the white paper, the HFMA said the model of two local ICS organisations risked adding complexity and bureaucracy to ICS governance and did not address ‘the conflict between system and organisational statutory duties’.

There was concern at the time the white paper was published that it would give too much power to the health and social care secretary. MPs said the bill should set out in detail the range and restrictions that will apply to the powers, including the ability to intervene in reconfigurations. It added: ‘We further recommend that the bill places a duty on the secretary of state to publish any direction made by his office, including responses by the affected body, and that such powers are implemented in accordance with a public interest test.’