Integration And Innovation: Working Together To Improve .

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Integration and Innovation: workingtogether to improve health andsocial care for allPublished 11 February 2021The Department of Health and Social Care's legislativeproposals for a Health and Care BillCP 381

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Integration and Innovation:working together toimprove health and socialcare for allPresented to Parliamentby the Secretary of State for Health and Social Careby Command of Her MajestyFebruary 2021CP 3813

Crown copyright 2021This publication is licensed under the terms of the Open Government Licence v3.0 exceptwhere otherwise stated. To view this licence, visit /version/3.Where we have identified any third party copyright information you will need to obtainpermission from the copyright holders concerned.This publication is available at www.gov.uk/official-documents.Any enquiries regarding this publication should be sent to us at Department of Health andSocial CareISBN 978-1-5286-2407-7CCS0221986560February 2021Printed on paper containing 75% recycled fibre content minimumPrinted in the UK by the APS Group on behalf of the Controller of Her Majesty’s StationeryOffice4

ContentsForeword. 61. Executive Summary . 8Working together to integrate care . 10Reducing bureaucracy . 11Improving accountability and enhancing public confidence . 11Additional measures . 12Next steps. 132. The role of legislation . 153. Our proposals for legislation . 20Working together and supporting integration . 21Reducing bureaucracy . 23Enhancing public confidence and accountability . 25Additional proposals . 274. Delivering for patients, citizens and local populations - supporting implementation andinnovation . 305. Annex A: Proposals for legislation . 33Working together and supporting integration proposals . 33Reducing bureaucracy proposals . 41Ensuring accountability and enhancing public confidence proposals . 46Additional proposals . 536. Annex B: Integration, partnerships and accountability. 70Working together . 707. Annex C: Stakeholder Engagement . 765

ForewordWe are living through the greatest challenge our health and care system has ever faced.Yet even in crisis conditions, everyone working in our health and care system hascontinued to deliver excellence. Critically, collaboration across health and social care hasaccelerated at a pace showing what we can do when we work together, flexibly, adoptingnew technology focused on the needs of the patient, and set aside bureaucratic rules.This paper sets out our legislative proposals for a Health and Care Bill. It aims to build onthe incredible collaborations we have seen through Covid and shape a system that’s betterable to serve people in a fast-changing world.At its heart, however, this Bill is about backing our health and care system and everyonewho works in it. Our proposals build on the NHS’s own – those in the Long Term Plan.We’re also outlining steps to support everyone who works to meet people’s health andcare needs. Taken together, they will help us build back better after Covid.First, by removing the barriers that stop the system from being truly integrated. We want tohelp Integrated Care Systems play a greater role, delivering the best possible care, withdifferent parts of the NHS joining up better; and the NHS and local government formingdynamic partnerships to address some of society’s most complex health problems. It willhelp us deliver our Manifesto Commitments, including 50,000 more nurses and 40 newhospitals.Second, we will use legislation to remove much of the transactional bureaucracy that hasmade sensible decision-making harder. The reforms will help enable us to use technologyin a modern way, establishing technology as a better platform to support staff and patientcare. Our proposals will maintain the distinct responsibilities between those who fundservices and those who provide care—which has been a cornerstone of efforts to ensurethe best value for taxpayers for over thirty years—but sets out a more joined-up approachbuilt on collaborative relationships, so that more strategic decisions can be taken to shapehealth and care for the decades to come. It’s about population health: using the collectiveresources of the local system, NHS, local authorities, the voluntary sector and others toimprove the health of local areas.Finally, our proposals will ensure a system that is more accountable and responsive to thepeople that work in it and the people that use it. Ministers have always been accountable,rightly, for NHS performance. Our proposals will ensure NHS England, in a new combinedform, is accountable to Government and the taxpayers that use it while maintaining itsclinical and day-to-day operational independence. We will introduce measures to enhancequality and safety in the NHS, including the creation of an independent statutory body tooversee safety investigations. Alongside this we will work with Local Authorities to developenhanced assurance frameworks for social care, that will support improved outcomes andexperiences for people and their families.These legislative measures are intended to support improvements already under way inthe NHS. They should be seen in the context of those broader reforms. And they are by nomeans the full extent of this government’s ambition for the nation’s health. We will alsobring forward changes in social care, public health and mental health. We also remain6

committed to the sustainable improvement of adult social care and will bring forwardproposals this year. The targeted public health interventions we have outlined here inrelation to obesity and fluoridation, sit alongside our proposals for the future design of thepublic health system, including the creation of the National Institute for Health Protection(NIHP). We are also bringing forward legislation to bring the Mental Health Act up to date,as set out in our White Paper last month.As we build back better after Covid-19, these proposals can help us look to the decadesahead with confidence. This is a unique moment when we must continue to build on theaudacious legacy that makes the NHS the very best of Britain. We must seize it.7

1. Executive Summary1.1We are living through the greatest challenge our health and care system has everfaced. The Coronavirus (Covid-19) pandemic caused an unprecedented externalshock, bringing intense pressure that could have been devasting to the systemitself and to all of us as individuals. And yet, the extraordinary dedication, careand skill of the people who work in our communities and our hospitals has beenunwavering, serving as a reminder once again of just how precious our health andcare services are to us all.1.2This is no ordinary moment. We have seen collaboration across health and socialcare at a pace and scale unimaginable even a little over a year ago. The NHS andsocial care providers have delivered outstanding care to those in need while at thesame time radically changing ways of working, reducing bureaucracy andbecoming more integrated. New teams have been built, adoption of newtechnology has been accelerated, new working-cultures developed, and newapproaches to solving difficult problems pursued. As a result, NHS capacity grew;new hospitals were built in just a matter of days; and new ways of treating patientshave become the norm. As we look towards the future and to the recovery of oursociety, our health and care system will continue to be central to our nationalwellbeing and prosperity in the years ahead.1.3In recent years, we have seen our health and care system adapt and evolve tomeet the challenges facing health systems around the world. Not only is ourpopulation growing in size, people are also living longer but suffering from morelong-term conditions. One in three patients admitted to hospital as an emergencyhas five or more health conditions, up from one in ten a decade ago. Whilesmoking rates may be decreasing; diabetes, obesity, dementia and mental healthissues are on the rise. Faced with these challenges, as well as those from Covid19, the case couldn’t be clearer for joining up and integrating care around peoplerather than around institutional silos – care that focuses not just on treatingparticular conditions, but also on lifestyles, on healthy behaviours, prevention andhelping people live more independent lives for longer. We need the different partsof our health and care system to work together to provide high quality health andcare, so that we live longer, healthier, active and more independent lives.1.4And so, this paper sets out our legislative proposals for a Health and Care Bill.Many of the proposals build on the NHS’s recommendations in its Long TermPlan, but they are also founded in the challenge outlined above. There will bethose who will say that this is simply the wrong time to make any kind of change inhealth and social care. Even if it will help the professionals who know best to dotheir jobs better, unhindered by systems and processes that might slow down oreven prevent them from doing their jobs in the way they would want to. The8

response to Covid-19 is our current priority but we must also prepare for therecovery of our health and care system and learn lessons from this experience.Our legislative proposals capture the learning from the pandemic and are drivenby the context of a post-Covid world, which is now in reach. And they makepermanent the innovations that Covid-19 has accelerated and encouraged thesystem to improvise new and better ways of working. Our proposals will help theNHS and local government in the immediate work of recovery from the pandemicby making joint planning and delivery of services easier, and over the long term byhelping to address the needs of everyone, from children to older people, atdifferent stages of their lives.1.5We have seen the brilliance of our doctors, nurses, carers and other healthcareprofessionals in providing world-class care to those in need. What has goneunseen by many is that in order to provide this level of care the traditional dividinglines between health professionals have been cast aside to allow unprecedentedlevels of collaboration.1.6If we are to improve the lives and life-chances of all in this country, no matterwhere they are from, their ethnicity or social background we must be ready forwhatever may come next.1.7The response to Covid-19 - led by those who know best - has shown us new waysto deliver care using innovative and creative solutions, exploiting the potential ofdigital and data, instead of needless bureaucracy. We must not go back to the oldways of working. The gains made through these new approaches must be lockedin.1.8The founding principles of the NHS – taxpayer-funded healthcare available to all,cradle-to-grave, and free at the point of delivery – remain as relevant now as theywere in 1948. Local government delivery is also rooted in firm foundations: inserving its residents, with strong local democratic accountability, and expertise inthe health, public health and care needs of its populations. To protect theseprinciples, which are so close to all our hearts, we must back those who makethem a reality every day of their lives - by building and constantly renewing aculture of collaboration.1.9Integrating care has meant more people are seeing the benefits of joined up carebetween GPs, home care and care homes, community health services, hospitalsand mental health services. For staff, it has enabled them to work outside oforganisational silos, deliver more user-centred and personalised approaches tocare, and tackle bureaucracy standing in the way of providing the best care forpeople. It enables greater ambition on tackling health inequalities and the widerdeterminants of health – issues which no one part of the system can addressalone. It both relies on the power of digital and data to join up care and uses that9

power to drive transformation of care. The experience of the pandemic has madethe case for integrated care even stronger and has redoubled the government’sdetermination to ensure that public health, social care and healthcare

of our health and care system to work together to provide high quality health and care, so that we live longer, healthier, active and more independent lives. 1.4 And so, this paper sets out our legislative proposals for a Health and Care Bill. Many of the proposals build on the NHS’s recommendations in its Long Term Plan, but they are also founded in the challenge outlined above. There will .

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