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Following the Government’s publication of their White Paper Integration and Innovation: working together to improve health and social care earlier this year, senior academics from the School of Social Policy at the University of Birmingham have responded to the Health and Social Care Select Committee inquiry which will examine the proposals made in the White Paper.

Their response examines the extent to which the proposals will deliver integrated health and care services, long-term plans for social care and the health and social care workforce. 

In this week’s Queen’s speech, the Queen introduced 26 pieces of legislation which included a Health and Care Bill which will seek to drive integration of health and care through the delivery of an Integrated Care System in every part of the country. The bill will lay the foundations for a more integrated, efficient and accountable health and care system - one which allows staff to get on with their jobs and provide the best possible treatment and care for their patients.  

The speech also referenced the Government’s commitment to improving the adult social care system and will bring forward proposals in 2021.

The submission was prepared by Professors Judith Smith, Jon Glasby and Robin Miller and draws on University of Birmingham health and social care research, highlighting what they consider to be the main risks and opportunities of the proposed legislative changes.  

  • We welcome the focus on enabling more integrated health and social care, which our research has consistently found to be beneficial to patients and their carers and accords with the NHS Long Term Plan and international trends in health and care policy.
  • Legislative change is likely to be helpful in simplifying and formalising some aspects of what is currently a very complex NHS policy and regulatory infrastructure, including a reduction in some unnecessary use of competitive tendering and related practices.
  • The arrangements proposed for the governance of local Integrated Care Systems appear very complicated and there is a need for greater clarity as to where decisions about capital spending, revenue allocation and service changes will be made and accounted for.
  • The focus on changes to organisations and governance as a means to achieve integrated care will likely prove very time-consuming and distracting in the short to medium term, given all that is known from research about the costs and consequences of structural reorganisation.
  • We are particularly concerned about the timing of some of the proposed changes, given the pressures facing both health and social care as they seek to recover from the pandemic, deal with long waiting times and lists for services, and all with a depleted and exhausted workforce. 
  • The commissioning function in the NHS faces a more significant organisational upheaval and reorganisation and this risks weakening further the role and influence of health planning, priority setting and commissioning.
  • The White Paper is focused on integrated health and social care, yet is largely concerned with proposals for the NHS, with relatively little attention to the vitally important planning and commissioning role of local government, social services and the third sector.
  • The proposals have less of an emphasis than expected on the role of primary care and general practice. Primary care networks have played a pivotal role in local responses to the pandemic, have significant potential to develop place-based care, and yet their role within Integrated Care System governance and decision-making is currently somewhat unclear.
  • The most glaring omission from the White Paper, and also from the Queen’s Speech, is a clear plan for reform of the funding of social care, and likewise of measures to address the highly constrained capacity of social care provision and workforce. 

View further information and read the full submission.