The Department of Health has today published its White Paper - "Integration and Innovation: working together to improve health and social care for all". The White Paper follows the 2019 NHS Long Term Plan and the consultation on NHS reform that ran from July 2020. It provides some of the most fundamental changes that the NHS has seen since the introduction of the Health and Social Care Act 2012.
A full copy of the White paper can be read here: [Integration and innovation: working together to improve health and social care for all (HTML version) - GOV.UK (www.gov.uk)]. It sets out:
- a Foreword and Executive summary, which explains the key objectives of furthering integrated care, reducing bureaucracy, and improving accountability and public confidence;
- Chapter 1 provides details on the "Role of Legislation" and how new laws will be needed to reform the commissioning of care and roll back certain aspects of the 2012 Act;
- Chapter 2 sets out "Proposals for Legislation" - which focuses on providing a statutory basis for the operation of Integrated Care Systems (ICS), comprising of CCGs, FTs, NHS Trusts and other local stakeholders, which may include independent health and social care providers.
- Chapter 3 - "Delivering for patients, citizens and local populations - supporting implementation and innovation" reiterates that legislation is no more than an enabler, and looks at how the legislation is designed to create real change;
- The annexes then go into further detail of the role and function of an ICS.
The White Paper covers a lot of ground, with wide-ranging, with implications for social care, food standards reform, advertising, competition law and patient data sharing.
The past year has highlighted, more than ever before, the need for integrated care - but it has also highlighted the increasing need for the NHS to draw upon all available resource, whether from NHS providers or independent healthcare providers.
Only this week, it was reported that independent providers had treated 135,000 cancer patients during the pandemic, according to data from the Independent Healthcare Providers Network (IHPN), including chemotherapy, diagnostic treatments and surgery.
The proposals also come at a time that NHS waiting lists have been reported nationally as growing from just over 1,000 to over 225,000, with the total number of patients on NHS lists at a 12 year high (see here: Year-long routine surgery waits 'worst since 2008' in England - BBC News)
The role of the private sector to support NHS care, whether through NHS e-Referrals (Choose and Book) or new models, will be essential to provide these people with access to care. The case here is clear for elective care.
What is less certain at this stage is how NHS Integrated Care Systems will be required (or not be required) to demonstrate, in the absence of competitive procurement procedures, that they are aware of and have taken into account the capacity and resource available from all available providers, whether for the delivery of care, or the integration of new technologies.
The paper does provide a signpost to further guidance to follow in this area, which will hopefully provide some welcome clarity and assurance that local care will keep all options open to improve care quality and capacity, rather than narrow the options available. Healthcare was a notable absence from the recent Green Paper issued by Cabinet Office on proposals to reform procurement law, leaving the door open to NHS England to create a parallel regime - that will be an important piece in this jigsaw.
Our team will be providing further updates on aspects of the White Paper in the coming days and weeks.