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What do legislation, collaboration and integration all have in common?

RCP’s president, Professor Andrew Goddard gives his view on the news that NHS England and Improvement has recommended an NHS integrated care bill.

Anybody remember the Health and Social Care Act in 2012? We find ourselves once again talking about legislative changes for the NHS. This time at least it feels different from the discussions that were had before Mr Lansley’s project. 

To their credit, NHS England has listened to voices from across the health and care system. They have successfully built consensus to create a set of proposals that seem to have the broad support of most stakeholders.

The week before last NHS England and Improvement’s joint board meeting discussed and agreed to recommend to government and parliament that consideration should be given to developing an ‘NHS Integrated Care Bill’. In their words “An NHS Bill should be introduced in the next session of Parliament. Its purpose should be to free up different parts of the NHS to work together and with partners more easily. Once enacted, it would speed implementation of the 10-year NHS Long Term Plan.

On that note, the RCP is today publishing a guide to help physicians understand and implement the changes announced in the Long-Term Plan to deliver more integrated care. The focus on the development of integrated care systems across England by 2021 means it is particularly important for physicians to get to grips with and help shape them.

Legislative change can be both a blessing and a curse. We know that most of our members and fellows just want to get on and deliver the best patient care they can but some of our members feel the effects of legislation more than others. Our members who work in and around public health services have particularly felt the consequences of the Health and Social Care act. As the NHS embarks on trying to change the legislative framework we’ve ensured that the voice of the profession has been heard. So far we have responded to NHS England & Improvement’s consultation and submitted evidence to the health and social care committee’s inquiry. 

One of the key things we have been calling for (along with others notably the Royal College of Nursing) is that any new legislation should include clarity on the roles and responsibilities of each part of the system in relation to workforce planning. NHS England’s summary of consultation responses highlighted our contribution: “A number of other respondents felt there should be greater clarity on which organisations are specifically responsible for ensuring adequate levels of funding for NHS staffing, including UNISON, and also the Royal College of Physicians: “the inclusion of a specific duty on the Secretary of State for Health and Social Care to ensure that there is sufficient workforce to meet the health and care needs of the population. Roles and responsibility of Arm’s Length Bodies (ALB) should also be clarified, ensuring that all the policy levers they need to ensure that the NHS has the workforce strategy and resources it needs are in place

Importantly there is a recognition that any proposals must be focused on supporting the system to work more closely together, reducing barriers to collaboration and removing the presumption of automatic tendering for NHS healthcare services. As these proposals are considered further, we’ll be watching carefully the development of the proposed new ‘best value test’, which will play a key new role in procurement decisions moving forward.

In many ways, this is very much the beginning of the process. The NHS may know the direction of travel it wants to achieve however the uncertainty of the current political climate means that we may be waiting a while for government and parliament to consider NHS England’s wishes.

Once more of the detail emerges, we will want to discuss the proposals in detail at RCP Council and also keep you updated as these proposals move closer to potential implementation.