The new Health and Care Bill: what it means for you
Caring Times looks at what the new Health and Care Bill could mean for the care sector and care leaders give their opinions.
The new Health and Care Bill is nothing if not ambitious. It sets out the biggest reforms to the NHS in nearly a decade. It aims to deliver an integrated health and social care system. And, according to the Department of Health and Social Care (DHSC) it seeks to build “a modern health and care system that delivers better care for our communities”.
Published by the Government this July, The Health and Care Bill 2021-22 (https://researchbriefings.files.parliament.uk/documents/CBP-9232/CBP-9232.pdf) presents how it intends to reform the delivery of health services and promote integration between health and care in England. It is the first major piece of primary legislation on health and care in England since the Health and Social Care Act 2012. The Bill’s introduction in the House of Commons on 6 July follows extensive discussions with NHS England, the health and care sector, and the Local Government Association to refine its blueprint.
According to the DHSC, The Health and Care Bill, “builds on the proposals for legislative change set out by NHS England in its Long Term Plan (https://www.longtermplan.nhs.uk/), while also incorporating valuable lessons learnt from the pandemic that will benefit both staff and patients”.
“The Government is committed to delivering world-class care for patients and this Bill will help deliver that by building on the NHS’ own proposals for reform to make it less bureaucratic, more accountable, and more integrated in the wake of Covid-19.
“These changes are vital to help the NHS build back better from the pandemic,” the DHSC says.
The Department says Covid-19 has “reinforced the need for closer collaboration between the NHS, local authorities and care providers to provide more joined up working, and staff and patients have rapidly adopted new technologies to deliver better care”.
“But at times in recent years the legal framework has made this more difficult, as it was not designed with this type of collaboration in mind,” the DHSC says.
The Bill sets into law Integrated Care systems (ICSs). These will be comprised of an NHS Integrated Care Board (ICB) and an Integrated Care Partnership (ICP). In England, Integrated Care Boards will be established as statutory bodies.
The Integrated Care Board will be responsible for the day to day running of the NHS, while the Integrated Care Partnership will develop an integrated care plan to address the system’s health, public health and social care needs.
DHSC says the Bill will “ensure each part of England has an Integrated Care Board and an Integrated Care Partnership responsible for bringing together local NHS and local government, such as social care, mental health services and public health advice, to deliver joined up care for its local population”.
“Clinicians, carers and public health experts will be empowered to operate collaboratively across health and care, as part of plans to tackle inequalities and level up health across the country” the Department says.
The Bill will also “dispose of unnecessary bureaucracy that has held the health service back so that health and care staff can focus on patients, not paperwork, and ensure the system is able to flex to changing needs in the years to come. It will ensure NHS England is more accountable to Government, and by extension Parliament, while ensuring the NHS retains everyday operational and clinical oversight”. the Department says.
Some of the key measures in the Bill include:
The NHS and local government coming together 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.
The development of a new procurement regime for the NHS and public health procurement, informed by public consultation, to reduce bureaucracy on commissioners and providers, and reduce the need for competitive tendering where it adds limited or no value. “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 DHSC says.
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 Department says.
The Health and Care Bill and the care sector
Other key proposals of the Bill that are particularly relevant to the care sector include:
A new duty for CQC to assess local authority’s delivery of their adult social care duties. The Secretary of State takes the power to intervene where, following assessment under the new CQC duty, it is considered that a local authority is failing to meet their obligations.
Maximising the power of data in social care. The Bill proposes a data strategy for health and care must be co-created with social care providers as well as users of care and support services. The first wave of the pandemic highlighted just how little data central Government and local Government held about adult social care – and in particular those who self-fund their care.
In response, DHSC adopted the Capacity Tracker and various local authorities created their own equivalents, all seeking to collect data from care homes at first, and now the wider adult social care sector, to inform the response to Covid-19. The Bill seeks to build on the Capacity Tracker by consolidating and centralising data collection from adult social care providers for DHSC and other parts of the health and social care system.
Extend the Secretary of State’s existing power to directly pay not-for-profit health and care providers to all care providers. This proposal follows the challenges during the pandemic of directing funding to the frontline of social care, and the limitations experienced by having to channel money via local authorities.
Discharge to Assess and the Better Care Fund. The Bill proposes to place a legal framework for a ‘Discharge to Assess’ model, whereby NHS continuing healthcare (CHC) and NHS Funded Nursing Care (FNC) assessments, and Care Act assessments, can take place after an individual has been discharged from acute care. This will replace the existing legal requirement for all assessments to take place prior to discharge.
The Health and Care Bill is currently on course to pass into law by April 2022.
Responses from the care sector
Care sector leaders talked to Caring Times about their thoughts on the new Health and Care Bill, what aspects they welcome, and areas of concern, including issues that the new proposals fail to address.
Overall, the reaction from the sector is that the Bill is a “missed opportunity” and that it is presented as being about health and care but is actually missing the ‘care’.
“It’s really a health Bill,” says Vic Rayner, CEO of the National Care Forum. “It’s hugely focussed on health, with a real lack of substance in relation to social care and the people who use care and health services. It only talks about care in relation to those who have health needs.
She says the Bill contains “very little of substance in relation to the long-term reform of social care and the plans for properly funded, long-term investment in the whole social care system”.
Rayner also points out that the Bill is “entirely silent on the very important issue of the social care workforce.”
“It really was a missed opportunity to start to share the Government’s thinking and plans for social care, while at the same time, committing to a significant overhaul and restructure of the systems within the NHS, which will inevitably absorb time, effort and resources at the expense of the long-term reform needed for social care,” says Rayner.
Instead, the focus is “too often on how social care can facilitate the objectives of the NHS, rather than how health and care work together to improve the outcomes and experience of those receiving care and support”, she says.
Nadra Ahmed, executive chairman of the National Care Association, says the Bill “doesn’t demonstrate any kind of transparent way in how it works towards an integrated approach for the people we care for”.
“It’s very much about the reconfiguration of the NHS and how that might function with a lot of delegated power to the Secretary of State to make decisions which may or may not be helpful in the long term.
“It’s disappointing as the individual strengths of health and social care could have been brought together to deliver exceptional services for citizens.”
She adds that a lot of the proposals are about “fixing what’s wrong now, but there’s nothing that tells me about a vision for the future for health and social care”.
Karolina Gerlich, CEO of The Care Workers’ Charity, is concerned that the Bill is “very clearly driven by the needs of the NHS and healthcare system”.
“As it stands, the content of the proposed document prioritises the NHS and healthcare services at the expense of social care – which is only seen as important in a supporting role for the NHS.”
She says this sets a precedent whereby social care is not recognised in its own right, and also risks medicalising social care due to the dominance of healthcare services in the relationship.
“We feel strongly that joined up working could represent an opportunity to increase service quality across health and social care sectors – but this will only work if both are on an equal footing,” she says.
“Social care providers and those needing care should be at ICS top table”
The ambitions for the ICS model “have to be welcomed “, says Rayner. “Who would not support the aims of improving population health and healthcare; tackling unequal outcomes and access; enhancing productivity and value for money; and helping the NHS to support broader social and economic development?
“The ICS model presents opportunities to join up health and care to bring it closer to the communities and people that need it and improve collaboration between all the partners and providers involved in making that happen,” she says.
A concern is that the ICS model is “far too health focussed” and misses two key elements of the wider local health and care system – that of the organisations that design, create and provide social care and those who use it or will need to use it.
“Social care providers and those who need care and support should be at the ICS top table alongside local authorities and NHS contracting authorities to design the services that they want to offer or want to use,” says Rayner.
“Social care must be seen as an equal partner in the ICS model – not merely as the handmaiden to the priorities of the NHS,” she says.
Proposals to introduce a new duty for CQC to assess local authorities’ delivery of their adult social care duties are “very welcome and long overdue”, says Rayner, “and we look forward to more detail on what exactly this will involve”.
“There is a real opportunity here for the CQC to use its overarching regulatory power to ensure that the wider health and care system in localities is meeting the needs of the people and communities they serve in terms of both the quality and choice of services available and in terms of the quality of commissioning practice,” she says.
While the proposals “certainly identify the problems in terms of consistent and accessible data for social care”, Rayner says “a better solution is needed.” “It isn’t enough for DHSC to simply centralise data collection,” she says.
To maximise the power of data in social care, the data strategy for health and care “must be co-created with social care providers as well as users of care and support services”, she says.
For Ahmed, there needs to be “more clarity” around the data being collected and what it is being used for.
With the proposals to place a legal framework for a ‘Discharge to Assess’ model, the NCF would like to see “good levels of funding to support this process, real choice for the individuals concerned and strong, collaborative relationships between commissioners and care providers”.
“Invisible army overlooked”
That social care could end up as the poor relation to the NHS in any move to integration “is always the risk”, says Ahmed. In the light of this new Bill, she suggests this risk has become “ever more pressing”.
“The ‘invisible army’ of social care is being completely overlooked and yet it’s the backbone of the NHS. The risk is by ignoring the role of social care this will weaken the vision for the NHS” she says.
As for what more the sector would like to see the Government doing to support staff,
Care England has identified five main areas where the Health and Care Bill “needs to be bolstered in order to assist real integration between health and social care”, says Professor Martin Green OBE, CEO of Care England.
Green says adult social care providers, for profit and not for profit, need to be directly represented on ICS NHS and Partnership Boards, and that there must be a ten year workforce plan that addresses adult social care.
Care England would like the framework around assessment of local authorities “to be subject to consultation and moreover created as well as co-produced by providers”.
Green says “every ICS needs to fulfil a certain level of awareness and understanding of adult social care”. Lastly, he says “social care plans need to be produced by the Prime Minister before ICSs come into effect”.
Rayner calls for investment in the workforce to create “a professionally skilled workforce, properly valued, better paid, with more training and development”.
She says the social care system “immediately needs additional funding of at least £7bn per year in England to simply stand still and deal with demographic changes, the fallout of the pandemic, uplift staff pay with the National Minimum wage and to protect those facing catastrophic social care costs”.
Gerlich says The Care Workers’ Charity would like to see the Government implement a ten year workforce strategy for social care “to address and recognise the challenges that these skilled professionals face, in addition to increasing funding to invest in the sector”.
“These should be key parts of the long awaited reform promised to us by the Government. Such reform of social care is an essential step towards improvement of care delivery across health and social care sectors, and we believe that this must be prioritised before the proposed Bill is implemented,” she says.
And crucially, for the integration goals of the Bill to be deliverable, she says “the social care sector and its professionals need be given the same parity, status and recognition as the NHS”.
The Government needs to invest in social care “in a way that will make it sustainable for the future, and unless they start thinking about that investment they will continue to let down the most vulnerable members of our community”, says Ahmed.
“We’re the only people who are standing up for them and supporting the most vulnerable, so our voices have to be heard more loudly. We have to believe in ourselves, as well as ensuring others understand what we do.”