Integrating health and social care - a new White Paper joining up care for people, places and populations

The proposals build on the foundations laid in the Health and Care Bill and centre around:

• Shared outcomes for health and social care at local level
• A ‘place level’ governance model for implementation by Spring 2023
• A review of section 75 arrangements (this is legislation that enables the pooling of budgets and integrated governance between NHS organisations and local authorities) with a view to promoting pooling of resources
• A review of the regulatory and statutory requirements that might stand in the way of health and social care staff working flexibly across settings
• The implementation of a single health and care record by 2024
• Each ICS to have a population health platform, with care coordination functionality, that will use joined-up data to support planning and proactive population health management by 2025

We look at what is being proposed and what to expect next.

What is being proposed?

The government is keen to make integrated health and social care a reality, pushing to go ‘further, faster’ towards that goal. This White Paper is seen as a further step in the ‘journey of reform’ towards achieving this.

Shared outcomes and governance at ‘place’ level

• Shared outcomes - Central to the government’s plan is the concept of an outcomes-driven approach at local level, bringing together the NHS and local government to deliver jointly on the key aims of delivering person-centred care, improving population health and reducing health disparities. To help with this, the government intends to produce a framework setting out a focused set of national priorities, plus an approach for local areas (‘places’) to develop their own local shared outcome priorities that meet the particular needs of their communities, supported by the Integrated Care Systems (ICSs) in which they sit. The White Paper also puts forward specific plans for the place-level governance structures needed to make this a reality - see further below. Implementation of this shared outcomes approach is to begin from April 2023.

• Shared accountability - Another key plank of the government’s plans for a more joined-up approach is for each ‘place’ to have a single person accountable for the delivery of the place-level shared outcomes outlined above. Who this accountable person is will need to be agreed by the relevant local authority/authorities and the ICB (Integrated Care Board). 

• Place-level governance model - How will delivery of the shared outcomes at local level be tracked and local leadership held to account on this? The government’s solution to this is for all places within an ICS to adopt a governance model which meets the characteristics set out in the White Paper (including, for example, clarity of decision-making for managing risk and resolving disagreements between local partners). Although places will be able to decide which governance model they adopt, the government has suggested the ‘place board’ model as one option. Under this model, a ‘place board’ brings together partner organisations to pool resources, make decisions and plan jointly, with a single person accountable for the delivery of shared outcomes and plans (as above). Under this model, the local authority/authorities and the ICB would delegate their functions and budgets to the ‘place board’. Integration of decision-making would be achieved through formal governance arrangements underpinning this. The expectation is that, by Spring 2023, all places within an ICS will have adopted either this suggested governance model or an equivalent model which achieves the same aims. In terms of how this will be regulated, the CQC will consider the accountability arrangements and outcomes agreed at place level as part of its assessment of ICSs.

• More pooled budgets - The White Paper also envisages going ‘further and faster’ in terms of the NHS and local authorities pooling and aligning funding to enable delivery at place level. Whilst there are no plans to mandate how this is achieved, the government says it expects the overall level of pooling of resources to increase in the years ahead. Acknowledging current barriers to achieving this, the government says it will be reviewing Section 75 of the NHS Act 2006 (which allows NHS bodies and local authorities to pool budgets and allow the exercise of certain functions by each other) to simplify and update the underlying regulations, as well as publishing revised guidance on the scope of pooled budgets.

The government says that, in Spring 2023, it also plans to appoint a set of ‘front runner’ areas to trial these reforms.

Shared data

The White Paper envisages a future where data flows seamlessly across all care settings. Whilst we are currently a long way off that, the government is keen to ensure that we harness digital advances to make sure this happens.

A key element of this is the plan for each ICS to ensure that, by 2024, everyone has a single health and care record, which all health and/or social care professionals they come into contact with can access (reiterating a commitment also made in the government’s draft data strategy, the final version of which is due to be published soon). 

The wider sharing of data between providers across health and social care is also seen as essential to the integration agenda, including by helping ‘place boards’ (or their equivalents) and ICSs to plan and deliver shared outcomes. To support this, the government proposes to establish a set of standards to enable providers across the NHS and social care to share information with one another. This will sit alongside the Health and Care Bill proposal to create a statutory duty on organisations within the health and social care system to share anonymous data. As a next step, the government will also be expecting each ICS, by 2025, to implement a population health platform, with care coordination functionality, that will use joined-up data to support planning and proactive population health management.

The White Paper also looks at how to push forward with the digitalisation of all care records, with the government saying it will take an ‘ICS first’ approach on this, which will include encouraging organisations within each ICS to use the same digital systems and expecting ICSs to work with partners to drive adoption of digital records across health and social care.

Workforce flexibility

Another important strand of the government’s vision for more joined-up health and social care provision, is to create a workforce that is properly supported to provide an integrated service.

With this in mind, the government says it will review the regulatory and statutory requirements that currently stand in the way of health and social care staff working flexibly across settings. It also plans to work with stakeholders to develop/test joint roles in health and social care, as well as considering the introduction of an Integrated Skills Passport that would enable staff to transfer skills and knowledge between the NHS, public health and social care.

To deliver shared outcomes, the White Paper says local leaders will need to think about what workforce integration looks like in their area, including who needs to be involved in shaping this and the practical steps required. Various examples of models to help implement this at place level are given, such as creating multi-disciplinary teams, physical co-location of staff or using a nominated key worker model.

What next?

These White Paper plans to create a more seamless health and social care system are inextricably linked with the Health and Care Bill proposals for restructuring the NHS, which are still going through Parliament and are not now expected to come into effect until July 2022 at the earliest.

Assuming that legislation goes through as planned, the steps this White Paper is proposing will follow thereafter, with key elements of this due to happen in line with the timescales below:

As the dust starts to settle on the form of the Health and Care Bill, and ICSs commence work on their proposed governance arrangements, it would be sensible for that governance design to factor in place-level governance models as a key pillar in those arrangements, in order to future-proof such arrangements as far as possible.

For more information, or to discuss the implications of this White Paper, please contact: Hamza Drabu, Charlotte Burnett or Alistair Robertson.