What does the Bill Propose?
The Bill, which is structured in six parts, focuses largely on the detail of how a new health and care system based on integration rather than competition will be structured.
The future landscape for the NHS and its partners will be made up of four interlocking elements:
- place, which for most areas (but not all) will usually be based on local authority boundaries.
- provider collaboratives,bringing together NHS trusts and foundation trusts to work more closely with each other. bringing together NHS trusts and foundation trusts to work more closely with each other to reduce unwarranted variation and inequality in health outcomes, access to services and experience and improved improve resilience by, for example, providing mutual aid. There are already eight NHS led Specialised Mental Health Provider Collaboratives in the South East
- integrated care systems (ICSs),bringing together commissioners and providers of NHS services with local authorities and other partners to plan and manage services that benefit from being considered at greater scale than can be undertaken at place
- the national and regional bodies, including NHS England and NHS Improvement, the Care Quality Commission (CQC) and the Department of Health and Social Care.
The Bill will allow for the establishment of Integrated Care Boards and Integrated Care Partnerships across England. This will be done at the same time as abolishing Clinical Commissioning Groups (CCGs).
The Integrated Care Board (ICB) will take on the NHS commissioning functions of CCGs as well as some of NHS England’s commissioning functions. It will also be accountable for NHS spend and performance within the system.
The Board of the ICB will, as a minimum, include a chair, the Chief Executive Officer and representatives from NHS providers, general practice, and local authorities. Beyond that, ICBs will have the flexibility to determine governance arrangements in their area – including the ability to create committees and delegate functions to them. This would, for example, allow systems to create local ‘place’-based committees to plan care where appropriate. ICBs will also need to ensure they have appropriate clinical advice when making decisions.
NHS England will agree ICBs’ constitutions and will hold them to account for delivery. NHS England guidance on ICB constitutions is imminent.
The Bill also enables the transition of commissioning responsibilities for primary care services and some specialised services to ICBs. Currently, this sits with NHS England, but primary medical care services have been successfully delegated to CCGs for some time.
Staff currently employed by CCGs will transfer to ICBs, and NHS England has made an employment commitment to staff to provide stability and minimise uncertainty.
Each area will also have an Integrated Care Partnership (ICP), a joint committee which brings together the ICB and their partner local authorities, and other locally determined representatives (for example from health, social care, public health; and potentially others, such as social care or housing providers).
The ICP will be tasked with developing a strategy to address the health, social care, and public health needs of their system, and being a forum to support partnership working. The ICB and local authorities will need to pay regard to ICP strategies when making decisions.
The ICB and ICP will also have to work closely with local Health and Wellbeing Boards as they have the experience as ‘place-based’ planners (HWBs act as a forum in every local authority with adult social care and public heath responsibilities. Leaders from the local health and care system could work together to improve the health and wellbeing of their local population)
The ICB will be required to have regard to the Joint Strategic Needs Assessments and Joint Local Health and Wellbeing Strategies produced by HWBs.
Key measures in the Bill:
- The NHS and local government coming together to plan health and care services around their patients’ needs including moving services out of hospitals and into the community, focusing on preventative healthcare.
- Proposals to give the Secretary of State for Health and Social Care powers to direct NHS England and to decide how some other health services are organised, to transfer functions between some of the arms-length bodies that lead, support and regulate healthcare services in England, and to intervene in proposed changes to the way health services are delivered.
- The development of a new procurement regime for the NHS and public health procurement, informed by public consultation, to reduce bureaucracy on commissioners and providers and reduce the need for competitive tendering.
- Oversight and accountability through new assurance measures in social care providing for the Care Quality Commission (CQC) to assess how local authorities deliver their adult social care functions; data sharing between the NHS and social care; updating the legal framework to enable person-centred models of hospital discharge, and introduce improved powers for the Secretary of State to directly make payments to adult social care providers where required.
- Public health measures in the Bill relate to food advertising and water fluoridation.
- The Bill would establish the Healthcare Safety Investigation Branchas a statutory body, and make changes to the system of medical examiners.
- These measures were previously introduced in the Health Services Safety Investigations Bill [HL Bill 4]in October 2019 and earlier draft legislation in 2017.
- Other matters covered by the Bill include the regulation of healthcare and associated professionals, the introduction of medical examiners, the collection and sharing of data (including measures to support the development of new medicine registries), international healthcare, the regulation of advertising of unhealthy food and drink, hospital food standards, and fluoridation of water supplies.
- The Bill contains 135 clauses (grouped into six parts), with 16 Schedules, and makes changes to several existing Acts including the National Health Service Act 2006 and the Health and Social Care Act 2012.
Part 1 – Health service in England: integration, collaboration, and other changes
Part 2 – Health and adult social care: information
Part 3 – Secretary of state’s powers to transfer or delegate functions
Part 4 – The Health Services Safety Investigations Body
Parts 5 and 6 – Miscellaneous and general
NHS England Guidance
The Integrated Care Systems Design Framework was published to support the ongoing progression and development of ICSs. It sets out how NHS leaders and organisations will be asked to operate with their partners in ICSs from April 2022.
All subject to legislation, it helps ICSs as they put in place the practical steps to prepare for their new functions that we expect to be enabled by legislation in this Parliamentary session.
In the drafting of this framework NHS England and NHS Improvement talked to a wide range of stakeholders including those representing patient voices, clinical and professional leaders, local government and many more.
Further guidance that has been issued includes:
NHS employment commitment guidance to provide those people in organisations directly affected by the proposed legislative changes with employment stability throughout the transition period while minimising uncertainty as much as reasonably possible
Direct commissioning Giving ICSs responsibility for direct commissioning is a key enabler for integrating care and improving population health. It gives the flexibility to join up care, leading to better outcomes and experiences for patients, and less bureaucracy and duplication for clinicians and other staff.
Subject to legislation ICBs could be responsible as early as April 2022 for the commissioning and arranging of primary medical services, dentistry (primary, community and secondary services), community pharmacy and general ophthalmology in the future with NHS England retaining a more limited oversight role.
By April 2023 all ICBs will take on delegated commissioning responsibility for a proportion of specialised services with national standards and access policies remaining at a national level.
Some other services may also be delegated including:
- Section 7A Public Health services
- Health and Justice, Sexual Assault and Abuse Service commissioning.
Commissioning healthcare for serving members of the Armed Forces and their families registered with defence medical services, veterans’ mental health and prosthetic services will remain with NHS England and Improvement.
Collaborating at scale guidance on the benefits, capabilities and governance of provider collaboratives and their role in systems which is on the NHS Futures workspace
A full suite of published guidance will be held on the NHS Futures workspace. It also has a full list of the documents currently in development. Key Guidance to be published will include:
- Interim guidance on the functions and governance of the Integrated Care Board
- ICB model constitution
- Statutory CCG functions to be conferred on ICBs
- Code of Governance for NHS Provider Trusts which will set out a common framework for corporate governance in trusts
- HR Framework
- Integrated care systems and the voluntary, community and social enterprise sector
- Guidance on working with people and communities
- Good practice guide to working in collaboration with Local Government.