Work the System: The Simple Mechanics of Making More & Working Less -- 3rd Edition

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This will be supported by a broad duty to collaborate across the health and care system and a triple aim duty on health bodies, including ICSs, as recommended by NHS England. This will require health bodies, including ICSs, to ensure they pursue simultaneously the 3 aims of better health and wellbeing for everyone, better quality of health services for all individuals, and sustainable use of NHS resources. As an additional safeguard for financial sustainability, we will take a power to impose capital spending limits on Foundation Trusts , in line with NHS England’s recommendation. We will implement NHS England’s recommendations to remove barriers to integration through joint committees, collaborative commissioning approaches and joint appointments , as well as their recommendation to preserve and strengthen the right to patient choice within systems. We will also legislate to ensure more effective data sharing across the health and care system, which is critical to effective integration, and will enable the digital transformation of care pathways. Separately set out proposals relating to adult social care also contribute to our ambitions in this area, including reconfirming the legal basis of the Better Care Fund, and changes to the legal functioning of the Better Care Fund, and changes to processes around discharge and assessment.

The creation of statutory ICS NHS Bodies will also allow NHS England to have an explicit power to set a financial allocation or other financial objectives at a system level. There will be a duty placed on the ICS NHS Body to meet the system financial objectives which require financial balance to be delivered. NHS providers within the ICS will retain their current organisational financial statutory duties. The ICS NHS Body will not have the power to direct providers, and providers’ relationships with the Care Quality Commission will remain unchanged. However, these arrangements will be supplemented by a new duty to compel providers to have regard to the system financial objectives so both providers and ICS NHS Bodies are mutually invested in achieving financial control at system level. The Department of Health and Social Care’s paper, busting bureaucracy: empowering frontline staff by reducing excess bureaucracy in the health and care system in England, sets out the government’s strategy for reducing excess bureaucracy. These actions are being taken forward through a variety of different projects, some led by the department, some by regulators and some by other bodies across the health and care system. Whilst we can do a lot to reduce bureaucracy through changing processes and culture, the Department’s engagement demonstrated that a lot of bureaucracy is also generated by the legislation which in some places is no longer fit for purpose and we therefore want to use this opportunity to amend legislation to resolve these issues. The pandemic saw the suspension of certain data collection requests from government and national bodies such as NHS England, NHS Digital and the Care Quality Commission. Where data collection was vital to the pandemic response, existing powers were used to publish notices requiring health and care bodies to share data to help manage and control the spread of COVID-19 within local systems. We will build on this approach and make changes to the regulations governing the sharing of data to enable more effective use of data for the benefit of individuals and the health and care system as a whole. enable NHS England to delegate or transfer the commissioning of certain specialised services to ICSs singly or jointly, or for NHS England to jointly commission these services with ICSs if these functions are considered suitable for delegation or joint commissioning subject to certain safeguards. Specialised commissioning policy and service specifications will continue to be led at a national level ensuring patients have equal access to services across the country Our experience of the pandemic underlines the importance of a population health approach: preventing disease, protecting people from threats to health, and supporting individuals and communities to improve their health and resilience. The government will publish in due course an update on proposals for the future design of the public health system, which will create strong foundations for the whole system to function at its best. These changes are driven by learning from the experiences of COVID-19, but more broadly by the need to ensure we have a public health system fully fit for the future. The factors which prevent poor health are shaped by many different parts of government, public services and the broader health system. So rather than containing health improvement expertise within a single organisation, driving change in the future will mean we need many different organisations to have the capability and responsibility for improving health and preventing ill health.remove the CMA function to review mergers involving NHS foundation trusts. The CMA’s jurisdiction in relation to transactions involving non-NHS bodies (for example, between an NHS Trust/ FT and private enterprise) and other health matters (such as drug pricing) would be unchanged Existing ICS arrangements are based on voluntary arrangements, rather than legislative provision, and are therefore dependent on goodwill and mutual co-operation. There are also legislative constraints on the ability of organisations within an ICS to make decisions jointly. While several systems have found ways to establish effective governance models, there are some obstacles and limitations in the current legal framework which inhibit this. For example, there is no legal basis at present for clinical commissioning groups ( CCGs), NHS trusts and foundation trusts ( FTs) to form a joint committee to which functions may be delegated, with the power to make decisions on behalf of the organisations within the ICS. This proposal will not impact on Parliament’s ability to scrutinise the mandate – each new mandate will continue to be laid in Parliament by the Secretary of State and will be published. NHS mandate requirements will also continue to be underpinned by negative resolution regulations, providing further opportunity for Parliament to engage with the content of the mandate. Furthermore, the existing duty for the Secretary of State to consult NHS England, Healthwatch England, and any other persons they consider appropriate before setting objectives in a mandate, will also remain in place. Healthwatch England’s involvement ensures that all NHS mandates are informed by the needs of patients and the public. Reconfigurations intervention power We are proposing to amend the Care Act 2014 (which sets out the functions and constitution of HEE and LETBs) to remove LETBs from statute. We believe removing LETBs from statute with their functions continuing to be undertaken by HEE (and reporting to the HEE Board) will provide HEE with the flexibility to adapt its regional operating model over time. Accompanied with our proposal for the Secretary of State for Health and Social Care to take a statutory duty to publish a document outlining the workforce planning and supply system at national, regional and local level, this measure will provide clarity over responsibilities.

The public largely see the NHS as a single organisation and as local health systems work more closely together, the same needs to happen at a national level. Recognising the evolution of NHS England, we are also bringing forward a complementary proposal to ensure the Secretary of State for Health and Social Care has appropriate intervention powers with respect to relevant functions of NHS England. This will support the Secretary of State, when appropriate, to make structured interventions to set clear direction, support system accountability and agility, and also enable the government to support NHS England to align its work effectively with wider priorities for health and social care. This will serve, in turn, to reinforce the accountability to Parliament of the Secretary of State and government for the NHS and the wider health and care system. The department recognises the significant pressures faced by the social care sector and remains committed to reform. We want to ensure that every person receives the care they need and that it is provided with the dignity they deserve. Our objectives for social care reform are to enable an affordable, high quality and sustainable adult social care system that meets people’s needs, whilst supporting health and care to join up services around people. We have committed to bringing forward proposals this year but, in the meantime, our legislative proposals will embed rapid improvements made to the system as it has adapted to challenges arising from COVID-19. Unlike NHS Trusts, which are set annual capital expenditure limits by NHS Improvement, NHS Foundation Trusts ( FTs) currently have additional freedoms to borrow from commercial lenders and spend surpluses on capital projects (for example, new buildings, equipment or IT). However, capital expenditure by FTs still counts towards DHSC’s overall Capital Delegated Expenditure Limit (CDEL).In their recommendations to government, NHS England recommended that NHS England and NHS Improvement should be permitted to merge fully, as requested by both their boards and strongly supported in the engagement responses.