Government reforms could improve care services for patients, say MPs

A Report by the Health and Social Care Committee into Government reforms of the NHS and social care is supportive of proposals, subject to accountability mechanisms on the safety and quality of care being built into legislation.

The inquiry into the White Paper, Integration and Innovation: working together to improve health and social care concluded that that the creation of Integrated Care Systems throughout England has the potential to improve the delivery of care services for patients. The Report welcomes a commitment from the Secretary of State to act on the Committee’s suggestion to include in the Bill provisions for independent ratings of the ICSs, to be carried out by the Care Quality Commission. MPs also call for amore detailed framework that sets out the roles and responsibilities of both the NHS Body and the Health and Care Partnership, with clear lines of accountability to ensure success.

On social care, the Committee urges that new legislation should impose a duty on the Secretary of State to publish a 10-year plan with detailed costings, within 6 months of the Bill receiving Royal Assent. Funding should be at the levels set out by the Committee in its Social care: funding and workforceReport. The absence of a fully funded plan for social care has the potential to destabilise Integrated Care Systems and undermine their success, and without secure long term funding problems that have bedevilled the care sector for decades would not be resolved, say MPs.

Rt Hon Jeremy Hunt MP, Chair of the Health and Social Care Committee, said:

“We broadly support the proposed changes provided the new Integrated Care Systems are held accountable for the quality and safety of care delivered through transparent CQC assessments. But we remain concerned about glaring omissions, including the lack of social care reform, and a much-needed overhaul of workforce planning.

“If such issues are addressed the government has an opportunity to deliver a post-pandemic watershed '1948 moment' for the health and care system, matching the significance of the year the NHS was founded. But if they are not, it will be a wasted opportunity to deliver the truly integrated care required by an ageing population.”

ENDS

Report welcomes:

• Secretary of State's commitment to include in the Bill, at Committee’s suggestion, provisions to enable the Care Quality Commission to undertake ratings of Integrated Care Systems
• Confirmation that statutory right of a patient to choose where they receive treatment will be retained in the forthcoming legislation

Among recommendations for inclusion:

• Secretary of State required to publish a 10-year plan on social care with detailed costings within six months of the Bill receiving Royal Assent
• CQC should be given powers to award Ofsted-style ratings for local authority social care
• Independent annual reports required to be published on NHS workforce shortages and future staffing requirements covering next 5, 10 and 20 years
• Provisions setting out in detail both the range and restrictions that will apply to each of the additional powers (of the Secretary of State) proposed, including transparency around ministerial interventions and the operation of the public interest test

A full list of conclusions and recommendations can be found in the attached Report

Workforce planning: ‘not adequate’ to address serious shortages in staff working in health and social care

Such are the pressures created by staffing shortfalls and their effects on patient care, that proposals to require the Secretary of State to publish updates on workforce planning and supply just once every 5 years was not an “adequate response”, say MPs. The Government should include in the Bill the requirement to publish independent annual reports on workforce shortages and future staffing requirements that cover the next 5, 10 and 20 years, together with an assessment of whether sufficient numbers are being trained.

Secretary of State’s additional powers: safeguards needed

The Report makes a number of recommendations to address proposals to grant new powers to the Secretary of State. MPs conclude that the White Paper fails to give adequate detail on how such powers would be used, with proposals lacking the necessary safeguards to ensure they do not open the door to the politicisation of the NHS.

Highlighted areas for concern with recommendations include: the need for full transparency in the appointment process for NHS boards; the operation of the public interest test relating to ministerial interventions; a duty on the Secretary of State to publish any direction made by their office; the criteria under which the Secretary of State may intervene in reconfigurations; duty be placed on the Secretary of State to lay before Parliament all information and advice in relation to an intervention in a reconfiguration; the use and restrictions of the power to transfer responsibilities of Arm's Length Bodies.

Integrated Care Systems:

The Report welcomes the commitment by the Secretary of State to ensure the Bill includes the Committee’s recommendation for the Care Quality Commission to undertake ratings of the new Integrated Care Systems.

A framework detailing roles and responsibilities of the NHS Body and the Health and Care Partnershipshould be set out in the Bill to ensure that both elements of the ICS can function efficiently and effectively, with proper accountability mechanisms.

Timeframe of reforms questioned:

The Report urges flexibility on the implementation of the proposals given the exceptional strain on the NHS during the covid-19 pandemic, with a number of witnesses questioning the need for a such a challenging timeframe. MPs call for flexibility as the scale of the post-pandemic backlog becomes clearer.

Further information:

The inquiry examined the proposals of the Department of Health and Social Care’s White Paper Integration and Innovation: working together to improve health and social care, and the extent to which the proposals will deliver integrated health and care services throughout England. It considered evidence on the extent to which the White Paper would deliver the necessary long-term plans for social care and the health and social care workforce, and proposals to give additional powers to the Secretary of State for Health and Social Care. Sir Simon Stevens, Chief Executive, NHS England, Amanda Pritchard, Chief Operating Officer, NHS England and NHS Improvement and Rt Hon Matt Hancock, Secretary of State for Health and Social Care were among those giving evidence.