BASW England Health and Care Bill briefing

BASW England is consulting with members on the proposals within the Health and Care Bill and the implications for social work.

A survey has been created for BASW members to capture views, inform the overall response and influence the next stage in the Bill’s passage/scrutiny by the Public Bill Committee.  All responses are anonymous and there is no requirement to answer every question.  Click here to complete the survey - deadline for responses is 20th August, 12 noon, 

Key reading:

The Health and Care Bill was debated for the first time in Parliament on 14th July 2021 and BASW England have been following developments closely, as well as consulting members of the BASW England Adult group to develop our response, since the launch of the White Paper earlier this year.  What is proposed will give the government greater control, with a stronger role in decision making at a national level.

The aim of the Bill is to move away from the marketisation of health and social care, deliver greater integration and partnership working, reduce bureaucracy and support ways of working between the NHS and social care.  The Bill, however, does not contain the long-awaited proposals we were promised for long-term social care reform. We expect these to come later in the year.

This briefing paper outlines plans contained with Bill within the key policy areas we are most focused on.  BASW members are advised to read this briefing in conjunction with the following documents which set out the views of BASW England in relation to each of the key areas outlined below:

Integration and collaboration

The Bill sets out changes to the NHS structuring by bringing together NHS England and NHS Improvement. This will mean the abolition of the NHS Trust Development Authority. The NHS Mandate, which is currently produced on an annual basis and sets out the government’s mandate to NHS England and Improvement set out their objectives and budgets, will be more flexible, and a mandate will remain in place until a new one has been developed.

The Bill will put existing Integrated Care Systems (ICS) on a statutory footing, including integrated care boards (ICBs) and integrated care partnerships (ICPs). This Bill also proposes the abolition of clinical commissioning groups (CCGs).  However, the Health and Wellbeing Board (HWB), part of the current structure, will remain in place and will be expected to collaborate with the ICS. While the ICS NHS ICS will have a board, it is not so clear as to how the ICS health and care partnership is to be governed and how the membership will differ from the HWB.

NHS England describes integrated care as “giving people the support they need, joined up across local councils, the NHS, and other partners. It removes traditional divisions between hospitals and family doctors, between physical and mental health, and between NHS and council services. In the past, these divisions have meant that too many people experienced disjointed care.”

The ICSs were developed over most of the country as Sustainability and Transformation Partnerships (STP) and are effectively collaboration partnerships between hospitals, Community Health and Local Authorities. NHS England and NHS Improvement had previously called on Government and Parliament to establish ICSs in law. This is what the Bill intends to achieve. Place based arrangements between local authorities, the NHS and between providers of health and care services are at the core of the integration plans and will be left to local organisations to arrange.

The ICB and partner local authorities will be responsible for setting up the ICP, bringing together health, social care, public health and, potentially, broader public services. The ICP will include, as a minimum, one member appointed by the ICB and one member appointed by each responsible local authority.  Members will be appointed at a local level with no requirement for citizens and organisations that represent them to be appointed. The Bill sets out a core, minimum membership of:

• Chair (appointed by NHS England and approved by the Secretary of State)

 • Chief Executive (appointed by the Chair and approved by NHS England)

• At least three other members, including: 
- one nominated jointly by NHS Trusts and Foundation Trusts (trusts)
- one nominated jointly by GPs and primary care
- one nominated by local authorities.

The Bill does not give further mandates regarding ICB membership and each ICB will need to manage any potential conflicts of interests for its members. Controversially, the Bill has no position, either in support or opposition, to the potential for corporate private providers to sit on ICBs.  The ICP will produce a strategy to address the health, social care and public health needs of its area. The ICB and local authorities will have to have regard to that plan when making decisions.

The structures proposed within the bill as outlined above are health driven, introducing new system leadership which could potentially bring an extra element of complexity and possible conflict into established multi – agency partnership arrangements.

New powers for the Secretary of State

The Bill also sets out the function of the Secretary of State for Health and Social Care. The Bill amends the NHS Act 2006 by inserting new sections which provide the Secretary of State with powers to give directions to NHS England regarding its functions, including public health.  The Bill would require the Secretary of State to be notified when an NHS body is aware of circumstances that it thinks are likely to result in the need for reconfiguration. This could lead to any service change in the NHS potentially landing on the Secretary of State’s desk, risking a decision-making log jam and placing a significant burden on local and national bodies awaiting decisions. Of particular concern is the intention to use these powers where there may be a temporary change to service provision to manage immediate operational pressures.

Discharge to assess

The Bill asserts that measures will be brought forward to “update approaches to hospital discharge to help facilitate smooth discharge, by putting in place a legal framework for a ‘Discharge to Assess’ model, whereby NHS continuing healthcare (CHC) and NHS Funded Nursing Care (FNC) assessments, and Care Act assessments, can take place after an individual has been discharged from acute care. This will replace the existing legal requirement for all assessments to take place prior to discharge.”

These proposals will involve amendments to the existing Care Act 2014 and the legal requirements relating to hospital discharge policy. The Care Act 2014 presently outlines a clear responsibility of local authorities to work together with health partners to ensure people have choice and control and are at the centre of any decisions made. The Wellbeing Principle forms a corner stone of the assessment process, care planning and provisioning of support and services.  There are fears about the dilution of social work’s role and contribution at key decision making points in the discharge to assess model which members have reported throughout the covid-19 pandemic.

Quality Assurance

The Bill will introduce a new legal duty for the Care Quality Commission (CQC) to review and assess the performance of local authorities in discharging their ‘regulated care functions’ under Part 1 of the Care Act 2014. These are the specific adult social care functions, which will be set out in secondary legislation, that will be subject to review by the CQC, with the aim of assessing the effectiveness of services put in place to achieve high quality care outcomes for local populations.

The CQC will publish the findings of their reviews with the intention of helping people see and understand how their local authority is performing in the delivery of its adult social care duties, and thus support transparency and local accountability. This new level of quality assurance is intended to support local authorities to understand what they are doing well and help them to identify what they could do better and inform DHSC of what is happening in the provision of adult social care at a local level.

These proposals form part of a wider assurance framework being developed by the department, which aims to “increase transparency and accountability across the Adult Social Care sector and in doing so, help people achieve the outcomes that matter to them in their life.”

Data and information sharing

The data provisions in the Bill are intended to work, collectively, to enable increased sharing and more effective use of data across the health and adult social care system. The provisions are informed by extensive work done by DHSC and its partners to identify barriers to - and solutions to ensure - the secure, appropriate, and proportionate use of data to benefit individuals, populations, and the health and social care system.  Much of this has been driven by Government learning in response to the COVID-19 pandemic.

The Bill introduces mandatory information standards which providers of health or adult social care to whom such standards apply will have to comply with. It is also intended to extend the potential application of information standards to include private providers of health and adult social care.  This provision may be able to address the ongoing issue of data collection on those who self-fund their care through their own resources.

DHSC is also introducing a power for relevant health or social care public bodies in England to require the sharing of information other than personal information for purposes related to their functions in connection with the provision of health services or adult social care in England. The requirement will only apply to information that is in a form that does not identify any individual or enable the identity of any individual to be ascertained, i.e. it is anonymous.