The health and social care white paper – some answers to big questions

by David Morris Health Services Sector Leader

Email +44 (0)7841 784180

A new white paper has set out the Government’s intentions to improve health and social care for everyone by building on the remarkable collaborations we have seen throughout the COVID-19 pandemic. It suggests a path of evolution rather than revolution, and it emphasises the duty to collaborate. However, there is much that it doesn’t explain – indeed it leaves some big questions unanswered.

We invited a cross-section of senior leaders from across the NHS to a roundtable event to reflect on the implications of the proposed legislation. These discussions highlighted concerns about how the system would work.

Two at the top... how to get the best from an unusual form of governance

Under the white paper’s proposals, each statutory integrated care system (ICS) will have at the heart of its governance, two boards - the NHS board and a Health and Care Partnership.

The NHS board will clearly be expected to drive the national ‘must be dones’ down the new, reinforced line of central control into the delivery system, while the Health and Care Partnership will enable partners, like local government and the wider voluntary sector, to set priorities and shape ICS allocations.

It’s an arrangement which covers all bases, but what if these boards disagree? It’s possible to imagine a clash of priorities and allocations emerging with one, for example, prioritising elective care recovery and the other wanting to focus on prevention and healthy early years.

Is there a hierarchy of boards? Is the independent ICS chair going to get a casting vote? It’s an interesting conundrum, and the white paper doesn’t give an answer.

Here are six ways ICS’s can get ahead of the white paper

Ensure all ICS board members understand and respect central Government’s right to set priorities (after all it spends and is accountable for over £140bn). But critically also ensure that they understand and respect the right of locally elected politicians to set local priorities based on their detailed knowledge and statutory duty to their populations. Balancing respect for these two dynamics will lead to an exciting and more effective set of priorities that can inspire huge achievements.

  • Avoid baking in siloed thinking. Local authorities will play a role, for example, in helping to get elective care waiting times down through their social care services supporting independent living, and effectively managing discharges in order to impact on both the ‘stock’ and the ‘flow’ of patients. So, allow them to join the NHS board. NHS trusts make a huge contribution to local economies, so let them take part in the work of the Health and Care Partnership. Cross-over membership will also help avoid factional decision-making.
  • Set out the major functions that the ICS will have to ensure are delivered - maintaining physical, social, and mental wellbeing; providing proactive and preventative care; providing reablement, residential, palliative, and rehabilitative care; providing urgent care; providing consistent elective care; and securing access to world-class specialised care - and then work out which of the two boards should lead on ensuring they are delivered.
  • Invest in good quality leadership by having job descriptions and person specifications for members, and offer great board development, so that they can address any difference of opinion and resolve disputes in a rational and intelligent way.
  • Encourage continuous public engagement to offer a route of arbitration based on public priorities, and avoid the lack of transparency and public engagement we saw in the early days of sustainability and transformation partnerships (STPs).
  • And finally, great shared data and intelligence that allows both boards to see the whole picture and make a shared evidence-based decision on priorities.

If you have any thoughts, or if you would like us to talk to you or your senior team or board, please get in touch and please read our further three blogs on the white paper.

by David Morris Health Services Sector Leader

Email +44 (0)7841 784180

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