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Proposed NHS legislation on integrated care: the RCP view

Dr Sarah Clarke, RCP clinical vice president, sets out the RCP’s view on initial proposals for NHS legislation to deliver more integrated care.

Two years ago, the NHS Long Term Plan was published – setting out a vision for triple integration between primary and specialist care, physical and mental health services and health with social care. The plan made clear that integrated care systems (ICSs) were central to achieving this aim, and that ‘amendment to primary legislation would significantly accelerate progress on service integration’.

As those legislative proposals have developed since 2019, the RCP has continued to provide feedback on behalf of members, including responding to an initial consultation by NHS England and NHS Improvement (NHSE/I) and providing evidence to the Health and Social Care Committee’s inquiry. Our recommendations on workforce planning and accountability were also quoted in the NHS’s recommendations to government and parliament for an NHS Bill in September 2019.

Responding to the pandemic obviously absorbed the focus of everyone in the health and care sector throughout 2020 and looks set to continue to do so for some time. However, work on integration is still happening, including looking at how we can lock in the system collaboration and integration we saw last year at a local level. Draft legislation will be brought forward this year to give more powers to ICSs to deliver more integrated health and care.

Last month we submitted a response to the latest NHSE/I consultation on what legislative proposals should look like. Our overarching message was that greater clarity is needed on the practical implications of what is being proposed, but this initial consultation allowed us to develop a set of principles to assess the legislation when it is published.

  • We support the principle of putting ICSs on a statutory footing, to provide the framework for a more integrated approach to delivering healthcare. We will need to consider how this change can happen in a phased way, so the practical challenges can be accurately assessed and addressed.
  • The pandemic has exposed and exacerbated existing health inequalities, and legislative change will need to be underpinned by measures to address these inequalities and support greater funding for public health. There will also need to be greater clarity on the role that the National Institute for Health Protection (NIHP) will play and where responsibility for population health will sit once Public Health England (PHE) is fully wound down later this year.
  • Close attention needs to be paid to the workforce planning element of integrated care for it to truly work. The development of a national workforce accountability framework will be key and must be agreed between the NHS, Health Education England (HEE), government and other relevant organisations. We also support the introduction of a duty on the secretary of state to ensure sufficient workforce.
  • Greater integration and working at a local level between organisations will be crucial, but we need to make sure that all relevant organisations and bodies are included, such as the voluntary, community and social enterprise (VCSE) sector.

Even with legislative changes, integration will not happen without teams across the country coming together and working differently. During the pandemic, with fewer regulatory constraints at the local level, there has been a huge amount of innovation in service delivery and working practices. We must learn from this and ensure local systems have this built-in flexibility so they can deliver care in the way that works best for their populations. Models of care are important to put policy into practice – so physicians should look to get involved in shaping change on the ground in their local areas.

We know that many RCP members who work in public health services have particularly felt the consequences of the 2012 Health and Social Care Act and our consultation showed understandable nervousness about another ‘top-down reorganisation’, especially in the context of the severe ongoing disruption to services that COVID-19 has caused. The changes to PHE for example have been a source of consternation for many professionals as it remains unclear where responsibility for improving the nation’s health will sit, even when the NIHP has been established. It is vital that these legislative changes are accompanied by a robust communications plan to ensure that NHS staff fully understand the proposed changes and the impact on their day-to-day work.

This is the first step on a journey to ensure that members’ views are heard and shape the legislation due to be brought forward this year. This will ensure the final legal changes enable our members and fellows to get on and deliver the best patient care they can.