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

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We are proposing to establish statutory ICSs, made up of an ICS NHS Body and an ICS Health and Care Partnership (together referred to as the ICS), to strengthen the decision-making authority of the system leadership and to embed accountability for system performance into the NHS accountability structure. This dual structure recognises that there are 2 forms of integration which will be underpinned by the legislation: the integration within the NHS to remove some of the cumbersome barriers to collaboration and to make working together across the NHS an organising principle; and the integration between the NHS and others, principally local authorities, to deliver improved outcomes to health and wellbeing for local people.

We are also planning to implement NHS England’s recommendation for a reserve power to set a capital spending limit on Foundation Trusts, which will support the third aim of the triple aim duty, in relation to sustainable use of NHS resources. At the heart of the changes being taken forward by the NHS and its partners, and at the heart of our legislative proposals, is the goal of joined up care for everyone in England. Instead of working independently every part of the NHS, public health and social care system should continue to seek out ways to connect, communicate and collaborate so that the health and care needs of people are met. Healthy, fulfilled, independent and longer lives for the people of England will require health and care services, local government, NHS bodies, and others to work ever more closely together. Different professions, organisations, services and sectors will work with common purpose and in partnership. This will be especially important when we seek to focus on the people and communities that are most in need of support. Legislation of all kinds needs to be carefully calibrated to make only necessary and proportionate changes. The risk of legislative overreach and of an excessive specification of detail, spelling out the exact conditions under which specific organisations can and cannot work together, can lead to burdensome bureaucracy and confusion for those faced with the task of implementation. As the pandemic has shown, there is a great deal of insight, commitment and innovation in local organisations. We need a legislative framework that builds on the trust we have for those within systems to understand and deliver what their populations need.Building on previous publications for legislative reform, NHS England set out details for how systems will accelerate collaborative ways of working in the future, considering the key components of an effective integrated care system ( ICS) and reflecting what a range of local leaders have said about their experiences during the last 2 years, including the immediate and long-term challenges presented by the COVID-19 pandemic We are also bringing forward several measures to improve accountability in the system in a way that will empower organisations and give the public the confidence that they are receiving the best care from their health and care system, every time they interact with it. The de facto development in recent years of a strongly supportive national NHS body in the form of a merged NHS England and NHS Improvement will be placed on a statutory footing and will be designated as NHS England. This will be complemented by enhanced powers of direction for the government over the newly merged body which will support great collaboration, information sharing and aligned responsibility and accountability. In addition, we will legislate to further ensure the NHS is able to respond to changes and external challenges with agility as needed. Measures will include reforms to the mandate to NHS England to allow for more flexibility of timing; the power to transfer functions between arm’s length bodies and the removal of time limits on special health authorities. An improved level of accountability will also be introduced within social care, with a new assurance framework allowing greater oversight of local authority delivery of care, and improved data collection allowing us to better understand capacity and risk in the social care system. Our measures recognise this, and we therefore plan to introduce greater clarity in the responsibility for workforce planning and a clear line of accountability for service reconfigurations with a power for ministers to determine service reconfigurations earlier in the process than is presently possible. Additional measures

Alongside the creation of statutory ICSs, we intend to introduce a new duty to promote collaboration across the healthcare, public health and social care system. Many existing duties on health and care organisations emphasise the role of the individual organisation and its own interests. We want to rebalance these duties to reflect the need for all health and care organisations to work collaboratively. When collaboration works well it leads to better outcomes for people, for example a successful early intervention can lead to people living independently and in their own homes for longer. While LETBs operate only in England, we will work with devolved administrations should this proposal have any UK-wide impact.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. The measures in this bill will help NHS organisations join up, to provide better care for the public and to plan services. None of the measures here will erode the protection of personal information. Patient choice

The original set of national NHS bodies has already altered in form and purpose, and in the proposed legislation, we intend to continue the work already undertaken to formally bring together NHS England and NHS Improvement into a single legal organisation. Alongside the role of competition in driving service improvement, it is also right that (as the newly merged body) NHS England’s main role is on supporting improvements in health outcomes, the quality of care and use of NHS resources. Arranging healthcare services To support closer working between actors in the health and care system, greater clarity is needed to enable joint appointments across different organisations.To allow the mandate to set direction over a longer term and in a more strategic way than currently permitted by the annual cycle, we are proposing to replace the current legislative requirement to have a new mandate each year with a new requirement to always have a mandate in place. It will also provide the flexibility for the mandate to be replaced to respond to changing strategic needs, emerging evidence on deliverability or appropriateness of objectives, or external events, rather than having to wait until the next annual opportunity. remove the requirement for providers to apply to NHS Improvement for local modifications to tariff prices remove the need for NHS England to refer contested licence conditions or National Tariff provisions to the CMA A great deal of the changes required were captured in the NHS’s recommendations to government and Parliament for an NHS Bill. These described the legislative changes the NHS needed to help it to deliver the improved outcomes set out in the NHS Long Term Plan. Both these documents were published with broad support in 2019. We are therefore proposing to create provisions relating to the formation and governance of these joint committees and the decisions that could be appropriately delegated to them; and separately, allowing NHS providers to form their own joint committees. Both types of joint committees could include representation from other bodies such as primary care networks, GP practices, community health providers, local authorities or the voluntary sector. Collaborative commissioning

Merging NHS England, Monitor and the NHS Trust Development Authority and Secretary of State powers of direction These reforms are not included in our legislative proposals but are part of a wider Departmental strategy.Further detail on our proposals for integrated care systems is set out at annex B, encompassing both the legislative and the non-legislative arrangements we intend to put in place. This is one of the most important elements of the legislative proposals, and we have sought to understand the hopes and concerns of a range of stakeholders in framing them. We have been particularly mindful of the importance of places within systems and of the enormous potential for joint working and innovation between local government and health partners that many of the vanguard ICSs have already demonstrated, while also recognising the distinct accountabilities of NHS bodies and local government. Reducing bureaucracy Turning effective innovations and bureaucracy busting into meaningful improvements for everyone, learning from innovations during COVID-19