The long-awaited Health and Care Bill was introduced to parliament this week, to begin the legislative process that is anticipated to see it brought into law by April 2022. As expected, the Bill covers a wide range of areas building on previous recommendations for legislative reform following The NHS Long Term Plan and the white paper Integration and Innovation: Working together to improve Health and Social Care for all. This article signposts some of the key points included in the Bill.
More detail about integrated care systems
- ICS make-up
The white paper referred to each integrated care system (ICS) being made up of two bodies - the ICS NHS Body and ICS Health and Care Partnership, the former of which was expected to be prescribed in more detail by the legislation. The Bill provides that detail, rebranding the ICS NHS Body as the Integrated Care Board (ICB). The ICB will be required to establish an integrated care partnership (ICP), which is the new term being used to describe what was known as the ICS Health ad Care Partnership. Together, these bodies will make up the ICS.
- ICB membership
The Bill prescribes the minimum membership for the ICB - a chair, chief executive, and at least three other 'ordinary members'. Those 'ordinary members' must include one nominated jointly by local NHS trusts/foundations trusts, one nominated jointly by local providers of primary care, and the third nominated by the 'local authorities whose areas coincide with, or include the whole or any part of, the ICB's area'. The chair must be appointed by NHS England (NHSE) and approved by the secretary of state. The chief executive is to be appointed by the chair, approved by NHSE, and must be an employee of the ICB.
- ICB constitution
The Bill also confirms that the ICB must have a constitution and provides details of what this must, and may, include. The constitution must specify who will appoint the ordinary members. NHSE will publish guidance on the selection of candidates. The constitution must also include decision making procedures and arrangements to secure transparency, together with arrangements for dealing with conflicts of interest.
- ICB committees/sub-committees
The constitution must also specify the ICB's arrangements for discharging its functions. The Bill confirms that these arrangements may include provision for ICB committees and sub-committees to do so. Those committees may include members who are neither members of the ICB, nor its employees.
- ICB duties
The Bill details a range of duties on ICBs. As expected, this includes the Triple Aim duty to have regard to the likely effect of its decisions on:
- the health and wellbeing of people in England;
- quality of services provided to individuals for or in connection with the prevention, diagnosis or treatment of illness, as part of the health service in England; and
- efficiency and sustainability in relation to use of resources.
- Other duties specified in the Bill include duties to promote the NHS Constitution, exercise functions effectively, efficiently and economically, to secure continuous improvement in service quality, to reduce inequalities, promote patient involvement and choice, to obtain professional advice, and to promote innovation, research, education and training, and integration.
Integrated care partnerships
The Bill requires ICBs, together with each 'responsible local authority whose area coincides with or falls wholly or partly within the board's area' to establish a joint committee, which it designates an Integrated Care Partnership (ICP). The ICP membership must include one member appointed by the ICB, one member appointed by each of the responsible local authorities, and 'any members appointed by' the ICP.
The ICP must prepare an integrated care strategy setting out how assessed needs in relation to its area are to be met by exercise of the functions of the relevant ICB, NHSE, or the responsible local authorities. More detail is provided in the Bill of factors that the ICP must have regard to in preparing the strategy, which include involving local Healthwatch organisations, and local people.
Merger/abolition of national bodies
As anticipated, the Bill includes provision to merge NHSE, Monitor and the NHS Trust Development Authority to leave a single body, NHS England. The explanatory notes with the Bill confirm that the aim of this is to provide national leadership speaking with one voice, remove unnecessary duplication, and use collective resources more efficiently and effectively to support local health systems and ultimately making better use of public money.
The Bill includes provision for 'relevant bodies' to arrange for its functions to be exercised by or jointly with either another relevant body, a local authority, or combined authority. Relevant bodies are defined as including NHSE, an ICB, NHS trust or foundation trust, and any other body as may be prescribed. Arrangements can include payment terms and restrictions on delegation. The ability to arrange for joint functions to be exercised by a joint committee and for a pooled fund to be established and maintained is also included. In making these arrangements, regard must be had to any guidance issued by NHSE.
The ability to issue guidance on joint appointments between these bodies is also included in the Bill.
Procurement and competition
As expected, the Bill includes provisions to remove current procurement rules applying in the case of NHS and public health services commissioners when arranging clinical healthcare services. There is also a power to enable a separate procurement regime taking these services out of the scope of the Public Contracts Regulations 2015, and section 75 of the Health and Social Care Act 2012 is repealed. These provisions will enable proposals previously consulted on by NHSE regarding a new provider selection regime to be taken forward.
The Bill removes the Competition and Markets Authority's powers on provider mergers, and its involvement in licensing.
The Bill includes provisions that are intended to enable increased data sharing across health and social care, including the collection of data from private health care providers. This includes a requirement for providers of health or adult social care to comply with 'information standards' rather than simply having regard to them. The Bill also includes a power for relevant health or social care public bodies to require that information which does not identify an individual, to be shared.
The Bill is wide ranging and we will be publishing further articles and insights dealing in more detail with the above, and other provisions shortly. In the meantime, should you require any further information, please do not hesitate to contact one of the team to discuss.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.