What does the Health and Care Act mean for the public and voluntary sectors?
06/27/2022
On 1 July, 42 Integrated Care Boards (ICB) will be established across England – a key milestone in the new Health and Care Act 2022.
The Act aims to provide a more cohesive, joined-up approach to delivering health and social care services within local areas. However, the legislation has thrown up as many questions as it answers – particularly around the issues of funding and liability.
What is the Health and Care Act?
While Integrated Care Systems (ICS) already exist across England, up to now these have been voluntary arrangements. The Health and Care Act will put them on a statutory footing, with the establishment of an ICB for each area. ICBs will take on the NHS commissioning functions of Clinical Commissioning Groups, which will be abolished.
The board of each ICB must, as a minimum, include a chair, a CEO and representatives from NHS providers, general practice and local authorities. Each area will also have an Integrated Care Partnership (ICP), a joint committee tasked with developing a strategy to address the health, social care and public health needs of their integrated care system.
What does the Health and Care Act aim to achieve?
By giving the new ICBs statutory powers, and by encouraging greater sharing of information between the various agencies in a local area, the Health and Care Act aims to break down barriers between different health and care services, leading to more effective collaboration and joint working. Ultimately, the aim is to more effectively respond to local health and care needs and deliver quicker outcomes for patients.
Areas of concern for public and voluntary sector organisations
For local authorities, one area of concern is how much influence they will have under the new statutory ICS arrangements, and whether a top-down approach will take power – and funding – further away from those tasked with delivering health and care services.
Rod Penman, Head of Public Services, Zurich Municipal, says: “There is definitely some concern among local authorities that the NHS will take the lead and that the local authority role will be downplayed.
“If you think back to how well local authorities responded to the pandemic – once they got involved with localised delivery, we began to get on top of things. There is a concern that the more centralised control there is, the less likely it is that service levels will be maintained, and that the money and the power will be focused away from the people who need to deliver the services.”
Another challenge could be the way the ICSs are structured. The NHS Long Term Plan says that for consistency, each ICS should have three distinct levels at which decisions are made:
- Neighbourhoods (populations of c.30,000 to 50,000 people)
- Places (c. 250,000 to 500,000 people)
- Systems (c. 1 million to 3 million people)
Gordon Wilmott, Head of Charities & Social Organisations, Zurich Municipal, says: “What’s confusing a lot of people is that these three levels don’t overlap easily with local authority structures.
“Conceptually, it makes a lot of sense to bring the NHS, local authorities and general practice together, but it’s unclear how this will work in practice.”
In areas where multiple local authorities are part of the same ICB – along with NHS and GP representatives – there is also a concern about how funding will be allocated.
Rod adds: “With so many different opinions and different agendas on these boards, will they look on each other with distrust? And will it be a case of ‘he who shouts loudest’ gets the most funding’? That’s an inherent challenge with this model.”
Will Integrated Care Systems create new liabilities?
Another area of uncertainty is who will be held liable if things go wrong.
“A lot of different organisations and individuals are going to be represented on these integrated care boards,” says Rod. “The concern could be that liability could come down the line to the local authority or charity involved in delivering the service, even though the relevant decision may have been made centrally rather than locally.”
The overriding issue is that many of the practical implications of the new statutory integrated care systems are not yet fully understood. While we do not have all the answers yet, it is important that organisations and individuals involved in these new systems are asking the right questions, and getting as much clarity as possible about what exactly they are signing up for.
