Does the Government's White Paper deliver the reform needed by the health and social care sector?
In February 2021, the Department for Health and Social Care published its White Paper, Integration and Innovation: working together to improve health and social care for all, setting out the Government's proposals for reform of the health and care sector.
The Department of Health and Social Care's White Paper's proposals
The White Paper describes the Government's proposals as “backing our health and care system and everyone who works in it”.
This would be done by:
- Removing the barriers that stop the system from being truly integrated through a greater role played by Integrated Care Systems (ICS);
- Removing transactional bureaucracy; and
- Ensuring that the health and care system is “more accountable and responsive to the people that work in it and the people that use it”.
We support the proposals in the White Paper that will be included in the new Bill and welcome the direction of travel in the Government’s reform of health and social care but have highlighted omissions and suggest ways in which it could improve.
Integrated Care Systems (ICSs)
The proposal to give a legal form to Integrated Care Systems (ICSs) is at the heart of the Government's proposals contained in the White Paper. The ICSs will comprise of:
- An Integrated Care System Body, that will be responsible for developing a plan to meet the health needs of the local population.
- An Integrated Care System Health and Care partnership, that will be responsible for supporting integration and developing a plan to address health, public health and social care needs of the area they cover.
Proposed Integrated Care Systems' aims are:
- Better health and wellbeing for everyone;
- Better quality of health services for all individuals; and
- Sustainable use of NHS resources.
The experts and organisations that we heard from were broadly supportive of the establishment of statutory ICS NHS bodies and Health and Care Partnerships. However, for many, the success of the new bodies would be dependent on the Bill setting out in detail how they would work together, their powers and the composition of their boards.
What we ask of the Government:
We recommend that the Government include in the Bill a more detailed framework that sets out the roles and responsibilities of both the NHS Body and the Health and Care Partnership and of the Chair of the ICS.
Proposals for social care
The executive summary of the White Paper states that “the Department recognises the significant pressures faced by the social care sector and remains committed to reform”.
Although there is no detail on the long-term reform of social care, the White Paper does contain a number of specific and targeted social care changes.
The absence of a long-term settlement for social care was a concern for experts and organisations working in the health and care sector that contributed to our inquiry:
"These reforms to health and care must go hand-in-hand with wider social care reforms which lead to significant, permanent, and sustainable funding."
This need was also recognised by Sir Simon Stevens, CEO of NHS England and Improvement:
"We support the need for proper reform of a well-funded adult social care system.[...] Everything we have seen over the last year has only reinforced the fact that health and social care are two sides of the same coin.
The Prime Minister has committed the Government to producing a 10-year plan on social care later this year, as he recently announced at a Liaison Committee meeting.
What we ask of the Government:
- Social care should be fully costed and funded as set out in our recent Report, Social care: funding and workforce.
- The Government must publish a fully-costed long term plan for social care within 6 months of the Bill becoming law.
Workforce planning
In the White Paper, the Government proposes that the Secretary of State for Health and Social Care should publish a document, once every 5 years, setting out roles and responsibilities for workforce planning and supply in England.
The experts and organisations across the health care sector that we heard from found this proposal inadequate.
"We need a workforce plan that combines measures you would take in the shorter term to support employers to improve retention, and to improve people’s skills in the workforce we already have, linking to the longer term."
What we ask of the Government:
To include in the Bill provisions to publish objective, transparent and independent annual reports on workforce shortages and future staffing requirements that cover the next five, ten and twenty years. These projections should cover both social care and NHS staff.
Powers of the Secretary of State
The White Paper proposes a number of additional powers that would be given to the Secretary of State for Health and Social Care.
They are:
- Direction to NHS England: the Secretary of State should be granted powers to make structured interventions in relation to NHS England to set clear direction;
- Reconfiguration of services: the Secretary of State should be given a power to intervene “at any point” in the reconfiguration process in relation to a Trust.
- Arm's Length Bodies: powers for the Secretary of State to transfer functions to and from specified Arm's Length Bodies, and where it is deemed necessary to the ability to abolish an Arm's Length Body.
The Secretary of State should have the appropriate levers to ensure that Government policy is delivered. However, the White Paper does not give enough detail on how these new powers would be used, nor does it set out the necessary safeguards to ensure the NHS does not become politicised.
What we ask of the Government:
- Powers of direction: we recommend that the Bill sets out in detail, the scope and areas of decision-making that will apply to this power.
- Reconfiguration of services: we recommend that the Bill set out the criteria for the Secretary of State to intervene in reconfigurations. We further recommend that a duty be placed on the Secretary of State to lay before Parliament all information and advice in relation to an intervention in a reconfiguration.
- Functions of arm’s length bodies: we recommend that the Bill sets out the use and restrictions of the power to transfer responsibilities of Arm's Length Bodies -including a list of bodies outwith the scope of the power. We further recommend that a procedure is put in place for Parliament to approve or reject such changes.
What's next?
The Government must now respond to our report.
Our report "The Government's White Paper proposals for the reform of Health and Social Care" was published on Friday 14 May 2021.
Detailed information from our inquiry can be found on our website.
If you’re interested in our work, you can find out more on the Health and Social Care Committee website. You can also follow our work on Twitter.
The Health and Social Care Committee is a cross-party committee of MPs that scrutinises the work of the Department of Health and Social Care and its associated public bodies.
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