Last reviewed 22 February 2021
NHS leaders were given much to think about when Health and Social Care Secretary Matt Hancock published proposals for more reform on 11 February 2021, in his White Paper, Integration and Innovation. But the social care sector has been left underwhelmed, wondering whether the structural changes for NHS planning, commissioning and procurement systems will affect social care at all.
The general feeling is that the White Paper fails to address key areas where reform is long overdue, but this is partly because the paper states that social care and public health will be dealt with “later in 2021”. The consultation reserved for “later” will outline social care reform with the two objectives of enabling an affordable, high-quality and sustainable adult social care system that meets people’s needs; while supporting health and care to join up services around people rather than around “institutional silos”.
The NHS reforms will do the groundwork in establishing structural improvements to enable more collaboration and integration across services. Meanwhile social care leaders, like Social Care Institute for Excellence (SCIE) Chief Executive Kathryn Smith, are left looking forward “to working with the Department to deliver what those who draw on, or work in, social care desperately need”.
The proposals for a Health and Care Bill aim to “enhance, support, spread and encourage" changes that are already underway, and accelerated by the sector response to the Covid-19 pandemic. Independent Care Group (ICG) Chair Mike Padgham welcomed the removal of legal barriers to greater integration but warned that if the Government fails to reform social care at the same time, care providers looking after older and vulnerable people “were in danger of again being left the poor relation to NHS care”.
What is the impact on social care?
The White Paper supports “joined up care between GPs, home care and care homes, community health services, hospitals and mental health services; care that focuses not just on treating particular conditions, but also on lifestyles, on healthy behaviours, prevention and helping people live more independent lives for longer”.
Care England CEO Professor Martin Green’s response, here, welcomed this opportunity and said: “We hope that these reforms will reshape the NHS and move us towards a system that is measured by the outcomes and which has a seamless interface between health and social care.”
To achieve this, integrated care systems (ICSs) will be established on a statutory footing through both an NHS ICS Board, which will include local authority representatives, and an ICS Health and Care Partnership. A more clearly defined role for social care will be created within the structure of an Integrated Care System NHS Board, giving adult social care “a greater voice in NHS planning and allocation”.
An ICS NHS body will be responsible for the day-to-day running of the ICS, NHS planning and allocation decisions. Meanwhile, the ICS Health and Care Partnership will bring together systems to support integration and develop a plan to address the systems’ health, public health, and social care needs.
The proposals will see a welcome end to competitive tendering for contracts, which were introduced by the “Lansley” reforms and brought in by the Health and Social Care Act 2012.
Local Government Association’s (LGA’s) Community Wellbeing Board Chairman Cllr Ian Hudspeth said the reforms formed a promising base on which to build stronger working relationships between local government and the NHS, “as equal partners”, but added that they did not address the need to put social care on a sustainable, long-term footing.
ICG Chair Mike Padgham agreed that the measures didn’t go far enough, saying: “We have argued for more than a decade that NHS care and social care need to be equal partners and ideally merged”. He admitted this would be hard when £8 billion had been cut from social care budgets since 2010, there are 100,000 social care staff vacancies, and people’s needs not being met.
What are the new duties and assurances affecting social care?
The organisational changes come with some new duties. A broad duty to collaborate is proposed across the healthcare, public health and social care system, and will apply to all partners within systems, including local authorities.
The Department of Health and Social Care (DHSC) will also work with local authorities to develop “enhanced assurance frameworks for social care”, which could have the potential to create more bureaucracy at a time when social care is still fighting Covid-19.
There will also be a new duty for the Care Quality Commission (CQC) to assess local authorities’ delivery of adult social care, and a new power for the Health and Social Care Secretary to intervene where there is a risk of local authorities failing to meet social care duties.
The LGA said assessments “would need to be contextualised in terms of available resources”, as any assurance process has the potential to highlight shortfalls in services and delivery of the Care Act’s intentions due to resource constraints.
SCIE’s Kathryn Smith said these proposals were welcome “as they aim to assure the public that social care in their area is fit for purpose”.
What are the additional measures relating to social care?
There is an additional section with measures designed to support social care, public health and safety and quality.
Social care payment power
A new social care payment power for the DHSC will be introduced by amending the Health and Social Care Act 2012. This overturns statutory limitations that prevent the Health and Social Care Secretary from making payments to all social care providers. The LGA said it recognised the Government’s desire for a mechanism that gets funding to social care providers quickly but added: “Local decision-making, local knowledge of the provider market, and local democratic accountability are important underpinnings of the system of social care funding and should not be bypassed; it is therefore helpful that the White Paper makes clear this power will only be used in exceptional circumstances.”
Discharge to assess
The Bill will put in place a legal framework for “discharge to assess”. This means there will be greater flexibility when discharging patients from a hospital to a care setting for assessment, allowing NHS continuing healthcare and Care Act assessments to take place after discharge from acute care. The LGA strongly supports the "discharge to assess” model, and its underpinning philosophy of “Home First”, which the LGA believes “advocates that home is the most appropriate place for resolving crises and recovery for nearly all people being discharged from hospital”.
To enact this, the Government needs to repeal existing requirements to assess for care needs prior to hospital discharge, and the accompanying process of assessment and discharge notices, which the LGA also supports.
Standalone Better Care Fund
Finally, the LGA also welcomed the proposal for creating a standalone power for the Better Care Fund, separating it from the NHS Mandate setting process, which will no longer be on an annual basis.
A new data strategy for health and care
Beyond the plans for new legislation, there are some other ongoing changes, including the development of a data strategy for health and social care.
This includes proposals to require health and adult social care organisations to share anonymised information that they hold between themselves where this sharing would benefit the health and social care system.
There will also be powers for the Health and Social Care Secretary to require the data from all registered adult social care providers about all services they provide, whether funded by local authorities or privately; and require data from private providers of health care. There will also be a power for the Government to mandate standards for how data is collected and stored.
The LGA has been eager to ensure “that any new data requirements or standards do not add to the reporting burden for social care without providing a proportionate benefit”.