The new Health and Care White Paper — A work in progress
Whilst it may feel that our health system is constantly being reorganised, legislative reforms to the NHS are relatively rare — the last major restructure was in 2012. So for Macmillan, the new NHS White Paper is a significant opportunity to achieve integrated, personalised services for people with cancer. There are a lot of questions still to be answered, including where Cancer Alliances and charities delivering services fit into the new local framework. However the overall direction of the reforms should simplify cancer commissioning and reduce the fragmentation of cancer services.
The 2012 Lansley reforms controversially introduced competitive tendering into NHS procurement, which opened the door to independent sector bidders. The new White Paper “Integration and Innovation” is emphatic: competition is out, collaboration is in.
Media reporting has inevitably focussed on the national picture (“Matt Hancock’s NHS power grab”). Notably the White Paper allows the Secretary of State for Health and Social Care “to formally direct NHS England in relation to relevant functions” on certain public health measures, local service reconfigurations and on the creation of new trusts.
On workforce, the Secretary of State has a new duty to publish a report every Parliament setting out “the roles and responsibilities for workforce planning and supply”. This sounds good from a public/parliamentary accountability angle, however we have questions about delivery. How will this reporting align with systems’ new responsibility for workforce planning? Where is the money to pay for it? And where is the promised long-term strategy to address historic gaps in the workforce supporting people with cancer?
What will the reforms mean for cancer services?
It is at a local level, where Macmillan’s partnerships and services add so much value to the NHS, that the success of the White Paper reforms will be measured. The paper drives forward a previous consultation on strengthening local systems in legislation, which Macmillan participated in. Broadly we welcome the direction of travel. Empowering local health and care services to improve their local populations’ health, including vital cancer care, makes sense.
Integrated care systems (ICSs) may sound jargony but on a practical level, should mean that local health and care services are better connected for people with cancer. ICSs already exist in many areas, and have shown promise. However, they don’t map directly across to Cancer Alliances, which cover wider footprints — Cancer Alliances’ input at system level is crucial for integrated, personalised care. We will also advocate for the voluntary, community and social enterprise sector, including Macmillan, as well as patient representatives, to be properly represented in the new strengthened ICSs.
Macmillan’s new research on integrated, personalised care highlights that we need a ‘whole systems’ approach for cancer care. This means joining up acute oncology with primary care follow up, with mental health teams, with the social care home packages to meet the individual person’s needs. The diagram above illustrates just how complex the cancer landscape is, and the extent to which services are commissioned and provided in different parts of the health and care system. There will therefore have to be some juggling and planning between alliances and systems to ensure that services align on key issues, such as system’s newly acquired powers over local budgets and wider workforce planning.
The White Paper also spells big changes for commissioning. Clinical Commissioning Groups (CCGs) will be replaced by in-house ICS commissioners. Specialised commissioning, which is vital for cancer treatments such as radiotherapy, chemotherapy and specialised surgery, will also be devolved to ICSs. However, the Department of Health and Social Care (DHSC) will retain a national role. This promises to simplify an incredibly complex commissioning environment and may make it easier to align cancer commissioning with other pathways. We’ll be looking for opportunities to influence the policy and guidance around the new commissioning process to make sure it enhances care for people with cancer.
What next?
The White Paper sets out opportunities to improve the health and care system, however there are a number of missing jigsaw pieces. There is no mention of the national funded workforce strategy that Macmillan has long called for. In the wake of the Covid-19 pandemic, this is needed more than ever, as an exhausted workforce faces the monumental challenge of restoring cancer services. There is not yet funding attached to the White Paper measures. We’ll be calling on the Treasury and the DHSC to give cancer services the funding they need in the Spring Budget and the Comprehensive Spending Review later this year. There is also no detail of plans for social care, though the Government has promised this is coming.
Although the White Paper doesn’t give us everything we want, it is a big opportunity for Macmillan to push for reforms that will best support the delivery of personalised, integrated cancer care. We will be looking to influence the legislation when it is published over the coming months and makes its way through Parliament. Watch this space!
