The new Health and Care Bill — a catalyst for health integration?
After months of speculation, the Health and Care Bill has finally been published and begun its parliamentary journey.
Many of the changes were trailed in February’s Health and Care White Paper so little is new. To recap, this legislation takes forward a 2019 NHS Long Term Plan proposal to strengthen Integrated Care Systems, (NHS and local authority partnerships delivering health services for their local populations) giving them budget-holding powers and legal accountability for running local services. The Bill also gives the Secretary of State controversial new powers to intervene in health service delivery.
For people with cancer, the Bill itself won’t radically reshape cancer services, and not a lot will look different. However, the Bill will mean profound changes for the health and care system in which Cancer Alliances and Macmillan teams are operating in.
What will the new ICSs look like?
The Bill confirms that ICSs will consist of two parts: an Integrated Care Board which controls the budget and spending for local health and care services; and an Integrated Care Partnership made up of local bodies responsible for providing and commissioning care. These will include local government and potentially independent sector organisations, Cancer Alliances and Voluntary, Community and Social Enterprise (VCSE) representatives. Partnerships are expected to draw up a strategy covering the health, social care, and public health needs of their local population. The involvement of charities like Macmillan in these partnerships would help ensure local people’s needs are being met.
The Bill has a strong focus on public involvement and consultation — the boards will be expected to involve patients and their carers/representatives in commissioning decisions. Partnerships will also be expected to consult local people and Healthwatch organisations when drawing up their strategies.
The Bill doesn’t affect the redrawing of ICSs to match local authority boundaries, as proposed by the White Paper. The Secretary of State’s decision about the six ICSs, which did not match local authority boundaries has now been published.
Workforce — no progress
One of the biggest constraints to health and care service collaboration is lack of staff. Yet the Bill doesn’t deliver the change we need. There is a new duty on the Secretary of State to clarify NHS workforce planning responsibilities — but without data on the future shape of the health and care workforce, this duty won’t help recruit and retain our cancer workforce. That’s why Macmillan will be campaigning with a coalition of health organisations on a joint amendment calling for these figures to be published annually for the health and social care workforce. We’ll also be campaigning strongly for investment in our cancer workforce, which has been put under immense pressure during this last year and a half.
National v local
New national powers over NHS delivery are the most contentious parts of the Bill. They give the Secretary of State powers to intervene in local hospital reorganisations and more broadly to “direct NHS England”. Macmillan recognises that for people with cancer, there are positives in the Department of Health and Social Care having extra accountability for health service provision. However, NHS organisations are concerned that this political involvement could threaten systems’ independence. This area is likely to be challenged as the Bill makes its way through Parliament.
Commissioning and delivering services
ICS boards will take over Clinical Commissioning Groups’ commissioning powers though NHS England will retain a role in some specialised commissioning e.g. for rarer cancers. Boards will have the power to set up committees to advise on commissioning decisions, giving scope for health professionals and Cancer Alliances to contribute. Separate guidance gives much more detail on how ICSs will be set up and work with local stakeholders, including Cancer Alliances. Macmillan submitted evidence to the team drafting the Bill and its guidance, calling for Cancer Alliances to be linked closely with ICS decision-making, so we are pleased that the guidance recognises Alliances’ role in leading “whole-system planning and delivery of cancer care on behalf of their constituent ICSs”.
Final thoughts and next steps
Ultimately health and care integration is about culture change, which takes more than legislation. This Bill will not be the ‘silver bullet’ that transforms the NHS. Our health services are still extremely fragile and another bad wave of Covid could further destabilise cancer services. Recovery requires major investment from an Autumn Spending Review, including funding to increase and better support our brilliant but exhausted cancer workforce.
The Bill is likely to be amended as it progresses through Parliament. However this means a tight parliamentary timetable to pass the legislation in time for an April 2022 start for the new ICSs. The details about how they will work with Alliances and provider collaboratives (networks of hospitals and providers working together) and the role of VCSE organisations is not in the Bill itself but in accompanying guidance. Macmillan will be continuing to influence the Bill and the guidance to ensure that the reforms enable everyone with cancer to have personalised, integrated cancer care.
