Appendix 2
East Sussex Health and Care Partnership
Brief Overview of the Integration White Paper: Joining up care for people, places and populations
On 9 February the government published a White Paper on health and social care integration called Joining up care for people, places and populations. This forms part of the Government’s wider plans to reform the health and social care system, and builds on the Health and Care Bill and the Social Care Reform White Paper People at the Heart of Care (December 2021), which set out the Government’s ten year vision for adult social care.
The Integration White Paper sets out a vision for integrated health and care services, and describes successful integration as the “planning, commissioning and delivery of co-ordinated, joined up and seamless services that support people to live healthy, independent and dignified lives and which improves outcomes for the population as a whole”. There is an intentional focus on the role of Place which is seen as the “engine for delivery and reform” within the Integrated Care Systems
The Government has been keen to underline the continuing flexibility available to local ICSs and Places in taking the White Paper forward in ways that are appropriate to local circumstances, and it is also inviting views in response to a series of questions to support effective implementation of the proposals by 7th April. Topics include outcomes, finance, accountability, workforce, and digital and data. The following summary provides a brief overview of the White Paper, and a next step will be to review our local integration plans in light of the details:
· Joining up care
o Better Place level integration across primary care, community health, adult social care, acute, mental health, public health and housing services which relate to health and social care
o Primary and secondary care to improve access to specialist support and advice,
o Closer working between mental health and social care services to reduce crisis admissions and improve quality of life for those living with mental illness;
o Integrating data across the board to inform new and innovative services to tackle specific problems facing communities, public health and the NHS joining up to get the most health gain at every opportunity
o Children’s social care is not directly within the scope of this White Paper, as this is currently subject to other national reviews, but ICSs are invited to “consider the integration between and within children and adult health and social care services wherever possible”
· New national shared outcomes framework
o A firm commitment to developing a new set of “shared outcomes” that will help better incentivise collaborative working across the NHS, social care, public health and also reflecting wider existing outcome objectives for local government.
o This will include space for prioritising shared outcomes at the local level for individuals and populations alongside national commitments, which Places will be able to choose based on local priorities and what matters to local people
o The CQC will consider shared outcomes agreed at Place level as part of its new duty (under the Health and Care Bill) to review ICSs as a whole, as well as when assessing local authorities’ delivery of their adult social care services.
o Implementation of national priorities and a broader framework for local outcome prioritisation to go live from April 2023
· Clear Leadership and accountability across Local Government and the NHS:
o A single person accountable for the delivery of the shared plan and outcomes working with local partners, agreed by the relevant Local Authority and ICB. NB This does not change Accountable Officer duties within local authorities or the ICB.
o Criteria and a suggested ‘Place Board’ model for formal place-level arrangements for organisations to pool resources, make decisions and plan jointly for delivery of shared outcomes, including effective commissioning and delivery of health and care services.
o Places can design their own equivalent models that meet the criteria for adoption by Spring 2023. As starting point arrangements should make use of existing structures and processes including the Health and Wellbeing Board and Better Care Fund.
o Where able Places should go further by putting in place extensive inclusion of services and spend to be overseen by place-based arrangements. All local areas should work towards this by 2026.
· Finance and integration
o Local leaders to have the flexibility to deploy resources to meet population needs through more aligned and pooled budgets across NHS and Local Government, to better use resources to meet immediate needs as well as support long term investment in population health and wellbeing
o Guidance will be developed to enable Local Authorities (LAs) and the NHS to go further and faster; simplifying the current pooling mechanisms such as section 75 of the NHS Act 2006.
o Fair and appropriate contributions will still be determined by NHS and LAs locally to support overall accountability for services and spend overseen by place-based arrangements.
o Guidance on the scope of pooled budgets will be published by Spring 2023
o Pooled or aligned budgets to become the routine to support more integrated models of service delivery, eventually covering much of funding for health and care services at Place level, linked clearly to shared objectives and delivery to improve outcomes.
· Workforce and carers
o Staff numbers and skills planning based on the needs of their populations and places, supporting the skills agenda in their local economy
o Career progression across the health and social care family
o ICSs to support joint health and care workforce planning at place level working with both national and local organisations
o The DHSC will improve initial training and ongoing learning and development opportunities for staff, create joint continuous development and joint roles across health and social care and increase the number of clinical placements in ASC for health undergraduates
· Digital and data
o There is a commitment to better digital integration between health and social care, including the intention for all providers within an Integrated Care System (ICS) to be connected to a ‘shared care record’ for each citizen by 2024.
o The paper also highlights some of the challenges that social care providers face with digital transformation and the importance of supporting them to become part of a shared future on data sharing and digital services with health
o ICSs to develop digital investment plans to bring all organisations to the same level of digital maturity to support seamless data flow across all care settings and use tech to transform care to be person-centred and proactive at place level.
o Supporting transparency: mandatory reporting of outcomes for local places