Legislative proposals an important step towards turbo charging integrated care for the public

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Responding to proposals published today by NHS England and NHS Improvement which set out options for formalising system working in England, NHS Confederation chief executive Danny Mortimer said:
“The development of system working over recent years has demonstrated the vital importance of collaboration and partnership working and we now have a rare opportunity to make this the organising principle of the NHS. The legislation proposed today is a measured but important step forward and will help us turbo charge the move to delivering more integrated care to the public. We are clear that this will be better for both patients and the taxpayer.
“For decades, the NHS legislative framework has centred around the principle of competition between organisations to improve the quality of services. Our members tell us this is no longer the best way to improve the health of local communities, deliver higher quality care, and make more efficient use of resources. Greater collaboration and partnership working have been a defining feature of the response to coronavirus and we need to formally embed this into how the NHS operates in future.
“There is often anxiety about ‘another NHS reorganisation’, but the NHS and the partners we work with across social care and other public services have been on this journey now for several years. In many ways, NHS and care organisations have worked in spite of the existing legal framework to foster better ways of working locally. But the current legal and regulatory restrictions will only take us so far. As such, we believe it is the logical next step to establish these partnerships as statutory bodies and build on the progress that has been made in recent years bringing together service provision, strategic commissioning and clinical leaders, all of whom will have an obligation to collaborate to improve the health of the communities they serve. 
“For the ambitions outlined in NHS England and NHS Improvement’s proposals to be achieved, the new statutory bodies will also need to be about much more than the NHS. They must be driven by collaboration, with partners across local government, social care, the voluntary sector, education and other public services involved as equal partners. This must be hard-wired into these bodies from the outset, with a key aim being a focus on establishing health equity for all communities.
“The ambitions of NHS organisations and their local partners risk being undermined without other policy responses, including long-term investment in training and education and capital, as well as a long-term, funded, plan for social care. There is also the need to find new models of oversight and regulation for these new ways of working, and to preserve the best of commissioning functions if they move.”    

The NHS Confederation will be engaging with its members from across the health system during NHSEI’s engagement process and will be responding in more detail next month. Read our member briefing.

Lou Patten, chief executive of NHS Clinical Commissioners, which is part of the NHS Confederation, said: 

“These proposals signal a really significant moment for clinical commissioners. CCGs have been hugely successful in developing the vitally important partnership between clinicians, managers and lay members. It has been enlightening over the past few years to have a strong united clinical view about major service changes, patient pathways and the principle of primary care being the cornerstone of patient-centred care. This sets a really strong legacy for Integrated Care Systems. 

"While recognising that the majority of commissioning functions will continue at ICS level in what is being proposed, the great work at neighbourhood and place, enhanced by the focus on the pandemic must continue. The local stewardship role of CCGs and their joint working with local authorities must not be lost – we cannot throw the baby out with the bathwater. 

"There is a huge amount of organisational memory within CCGs, and we must ensure staff are retained to continue the current and future commissioning responsibilities. I appreciate how this will land today with hard-working and Covid-weary staff, and that’s why NHSCC, as the only member body for CCGs, will work closely with NHS Confederation colleagues and the ICS network to support members every step of the way to transition. We will seek to influence NHSEI at the highest level in order to minimise disruption and destabilisation, consolidate the positive, and that way we can ensure the fantastic legacy of CCGs lives on in ICSs."

Ruth Rankine, director of the NHS Confederation's PCN Network, said:

“Primary care network leaders were the least supportive of the health and care leaders we surveyed recently about ICSs becoming statutory bodies because of the level of unrest this could create at a local level at a time when PCNs are still developing and have a lot to deliver. 

“However, the proposals set out in the paper today presents a pragmatic way forward and we particularly welcome the recognition that PCNs have a key role and must be included in the place and system level governance. 
“This will not be without challenges, however, and as part of this journey we will be asking NHS England and NHS Improvement to ensure that CCG resources can be repurposed to support PCNs with their development, thereby protecting both the PCN funding for front-line roles and the valuable expertise of CCG staff.”

Sean Duggan, chief executive of the NHS Confederation’s Mental Health Network, said: 

“The proposals present the welcome opportunity to embed better mental health provision across the wider health and care system.

“We must ensure that any legislation ensures an equal footing for mental health and that providers are not overshadowed by acute sector needs. It will also be important that voluntary and independent sectors, and local authorities are true partners in this endeavour.

“We know that improved mental health services play a role in reducing demand on secondary services across the entire system through improving recovery rates, better management of long term conditions and speeding up discharges.

“We particularly welcome the proposal to align specialist commissioning with linked care pathways to support patient care. This is important as currently the split in commissioning mental health support can lead to fragmented care pathways.
“It will also provide an opportunity to take a more population health-based approach, which will help reduce unacceptable inequalities and support people to stay well.”

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