Agenda item

NHS White Paper - Integration and Innovation: Working Together to Improve Health and Social Care for All

Minutes:

The Board received a paper providing a briefing on the recently published NHS White Paper “Integration and Innovation: Working Together to Improve Health & Social Care for All”.  The Secretary of State for Health and Social Care had asked NHS England in 2019 to identify and consult on what legislative changes were needed to fulfil the ambitions of the ten-year NHS long term plan, the White Paper being the result.  The White Paper did not cover broader social care reform, giving instead a commitment to publish proposals for reform in the current year, but it did give some direction of travel for adult social care and for changes in public health.

 

The proposals in the White Paper were considered in the following themes –

·         working together to integrate care – proposing statutory Integrated Care Systems (ICSs) with “dual structure” governance arrangements;

·         reducing bureaucracy, including the removal of requirements on competition and procurement in the NHS; and

·         improving accountability and enhancing public confidence – proposing the formal merger of NHS England and NHS Improvement and new powers for the Secretary of State.

Additional proposals, many related to public health and adult social care, would be set out in a Health and Care Bill, with legislation in place for implementation in 2022.

 

The principal focus of the briefing related to the working together to integrate care theme, it being noted that the forthcoming Health and Care Bill will support two forms of integration.  Firstly, through the removal of barriers within the NHS and making “working together an organising principle”, NHS bodies were to have a “triple-aim” duty of better health and wellbeing for everyone, better quality of health services for individuals, and sustainable use of NHS resources, the intention being to help align NHS bodies around a common set of objectives with strong engagement with local communities; and secondly  through greater collaboration between the NHS, local government and wider delivery partners to improve health and wellbeing outcomes for local people. 

 

Local authorities and NHS bodies would be expected to work together in the ICS under one system umbrella. ICSs would be put on a statutory footing to allow stronger and streamlined decision making and accountability and have “dual structure” arrangements reflecting the two forms of integration – an ICS NHS body (or Board) and an ICS Health and Care Partnership, the composition and roles of each being considered in the briefing.  The briefing further outlined proposals in respect of each theme and noted the government’s recognition of the significant pressures faced by the social care sector and the intention to bring forward proposals for reform aimed at ensuring everyone can access affordable, high quality, joined-up and sustainable adult social care.

 

Comment was made as to the need to fight to ensure that appropriate structures were introduced for Oldham, ensuring that local decision making that maintained the One Oldham approach was delivered, and ensuring that the voluntary sector was included in commissioning arrangements and thrived.

 

With regard to Social Care, it was noted that the Chancellor had been silent on the adult social care funding challenge in his recent financial statement, and reference was made to confusion around charging and the failure to enact provisions in Part 2 of the Care Act.  The new assurance framework and the role of the Care Quality Commission in assessing delivery of local authority services was noted, though discussion was ongoing as to the form this might take.  Arrangements regarding discharge assessments were similarly in need of further detail and consideration.

 

The frequent reference to Public Health in the White Paper was noted, though the need for further detail was suggested.  References to obesity and fluoridation appeared as very specific issues, but it was suggested that this might relate to the requirement for primary legislation to introduce powers for the Secretary of State.

 

Possible future arrangements for Oldham were further considered, including the process by which Oldham could control what happens in Oldham, and the need to ensure that health inequalities, not explicitly written into the White Paper, were addressed and written into local modelling.  The work ongoing at the various Boards across Greater Manchester to consider future arrangements was outlined.  The White Paper strengthened the role of localities, and there was discussion around what would happen in Greater Manchester moving forward, what activities would take place where, and the implications of the disappearance of the CCGs.

 

RESOLVED that the report be noted.

 

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