Update on the health and social care integration white paper
The Department of Health and Social Care (DHSC) have recently published their proposals for the health and care integration white paper, ‘Joining up care for people, places, and populations’. The white paper aims to provide improved, joined-up health and care services at a ‘local’ level across primary care, adult social care, acute mental health, community health, public health and housing services that relate to health and social care. Whilst there have been attempts over the last few decades to refine and consolidate integrated health and care services, it has largely been overlooked and the current policy falls short of achieving successful integration.
The white paper covers a relatively wide range of matters: governance, leadership, budget pooling, oversight, digital and the workforce. It is certainly ambitious, and it will require commitment from national partners, Government, NHS leaders and local government. There is also the need for adequate investment and funding from Government in terms of this realistically progressing.
Both the Local Government Association (LGA) and NHS Confederation advise that they broadly welcome the direction the white paper sets out. The LGA states that the values, ambitions, the scope of the paper, as well as placing people and communities at the centre of integration policy are all encouraging. They state that integration is not an end in itself, but as a means of achieving better outcomes in terms of health for communities, and that this is acknowledged in the white paper.
The NHS Confederation advise that whilst the overarching themes are welcome, the proposals are more akin to a green paper as there are several issues that require further clarification and exploration. There has been criticism that it does not achieve much in terms of furthering the agenda or debate, as it largely reinforces existing policy. Indeed, the NHS Confederation asks, ‘what will this white paper enable which cannot already be done?’ They conclude that the answer to this seems to be very little which aligns with the CfGS view. The white paper in its first iteration does not appear to provide resolution to many longstanding issues, but as the white paper passes through parliamentary scrutiny, we are hopeful that some of these will be ironed out and resolved.
In terms of the content, with regards to governance, the white paper sets out that all local authorities and integrated care boards (ICB) must adopt a governance model by Spring 2023. It states that central government will set out the criteria for this, but an ‘equivalent’ can be adopted. The DHSC’s criteria stipulates that the new governance model must include a clear, shared plan where delivery can be monitored against, and it should be supported by pooled and aligned resources. Local politicians, and particularly those performing a scrutiny role, must be able to be able to meaningfully scrutinise this governance model before it is adopted, ensuring that it will work for all involved partners and stakeholders. Additionally, whilst it is welcome that the ball is rolling, the timescale of spring 2023 may be quite tight for many local councils and ICB’s in terms of implementing this new model of governance
The leadership element of the white paper sets out the intention for there to be one singular person that is accountable for the delivery of the shared plan and the subsequent outcomes in each “place”, or local area. This person will be agreed upon by the relevant local authorities and the ICB. We believe that this appointment raises some important questions. This person will be accountable to the relevant authorities and the ICB, but how will this work in practice? In terms the delivery and outcomes undertaken by the selected person, will these be subject to scrutiny? Will there be a consultation process in terms of selection, and will the health overview and scrutiny committees have a say into this? The LGA have suggested that in many places, they may wish to consider joint appointments to this role, due to its scope. Questions surrounding this matter require clarification to ensure that proper scrutiny measures can take place.
The white paper provides guidance on budget pooling and advises that councils and relevant partners, such as the NHS, must do more to align and pool budgets. DHSC states that budget pooling will continue to be controlled by councils and the NHS and that it is within their remit to agree, at place level, what is fair. We believe that this continuation of policy is positive, as local partners can better recognise their own budget needs collectively – it fits with the spirit of the creation of a more holistic health and care system. It is important that the budget needs of care systems across the area are carefully considered. Again, we think that these plans should pass through the relevant scrutiny committee before final decisions are made to ensure proper transparency and accountability.
The CfGS will continue to follow this matter closely and you can read more about the white paper here: CP 573 – Joining up care for people, places and populations – The government’s proposals for health and care integration (publishing.service.gov.uk). If you have any views about the white paper, you are able to contact DHSC directly here iwpimplementationquestions@dhsc.gov.uk and this mailbox will be open for eight weeks from 10 February 2022.
