What is the Health and Care Act?
When I was about 10, I wrote (no email then) to the Houses of Parliament asking for any information they had on how the place worked. (Yes, I was that sort of child). What came back was a big envelope full of interesting (that sort of child…) stuff, including a whole section on how a law got made. As I recall, the law in question was about beekeeping – but it was the lifecycle of the Bill rather than the bee that caught my attention. Perhaps a little of that early interest stayed with me when I applied to work on what has now become the Health and Care Act 2022.
One of the things that my envelope from Parliament didn’t quite convey was just how many people and organisations are involved in making and refining legislation. It can often seem that the process is incredibly slow, but some of that slowness is because of the discussion, engagement, deliberation and debate that happens within but also beyond Parliament. As we developed the legislation we were incredibly lucky in the support, challenge and insight we received from a wide range of stakeholders – including National Voices – and I have no doubt that we made many improvements, large and small, to the legislation as a result. Every conversation, briefing or discussion we did gave us something new to think about.
We were also keen to have as many conversations of this kind as we could because at the heart of the legislation were the ideas of collaboration and integration. These are ideas that have proved their practical worth in health and care over a number of years, and the legislation seeks to provide a legal framework to make it easier for health and care organisations to work together in the interests of the people they serve.
Along with collaboration, another key feature of the legislation is to enable flexibility- we have sought to avoid imposing a single blueprint on what is an incredibly diverse health and care system. And flexibility and adaptability are certainly helpful characteristics to have in supporting legislation through Parliament – the Department’s Bill team certainly had to be incredibly flexible on many occasions.
A core component of the Act is building upon the voluntary Integrated Care Systems, by creating 42 Integrated Care Boards (ICBs) in statute across England to carry out commissioning functions and be accountable for spend and performance. Each ICB will, in partnership with their Local Authorities and other locally determined representatives, create a corresponding Integrated Care Partnership (ICP) to develop a strategy for addressing local health and care needs. This means that the NHS, local government and local stakeholders can work together to develop systems that deliver for the communities they serve and adapt these to meet the challenges they face over time. The new statutory ICBs will each agree a constitution and have the flexibility to establish and delegate different committees and structures to create more effective ways of working.
The Act contains a large number of other measures that will make a real difference to people’s lives include establishing the Health Services Safety Investigations Body (HSSIB) to make services safer for patients, implementing mandatory specialised training for the care for autistic people and people with a learning disability, banning virginity testing and hymenoplasty to better safeguard women and girls, regulating non-surgical cosmetic procedures, and explicitly setting out the need for parity between mental health and physical health. Some of these provisions were there at the introduction of the Bill, while others were put in place through a process of amendment and debate.
Legislation can be a helpful enabler of change, but it can only be the start of a process of change and improvement – especially permissive legislation of the kind set out in the Health and Care Act. Integrated Care Systems are now forming ahead of coming into statutory form in July, and they are working to define and tackle the issues that are most important for their populations – while also learning from one another, and building a formidable network for improvement and innovation. One of the real strengths of the ICS model is that it encourages the organisations within it both to work more closely together and to look outwards into local communities and to connect their endeavours with the wider economy, education and society. The Integrated Care Partnership element of the ICS will be especially important here. To ensure the care delivered by local systems is fundamentally person-centred, ICPs will need to bring together local and voluntary partners, alongside health and care providers, to support people to retain their independence, health and wellbeing for longer. They must also facilitate important partnerships with groups representing the public and patient perspective and the voluntary, community and social enterprise (VCSE) sector to work across barriers if effective integrated system working is to be achieved. This is not only because VCSE groups and organisations have the relevant expertise and foundations to meet the specific needs of different communities, as many are service providers themselves, but because they can also represent the perspectives of these communities in the ICP itself and help to shape the provision of health and care services to ensure the right needs are met.
The Health and Care Act is another step on a journey that began a long time ago. The Act provides a legislative framework for the ways of working that the health and social care system had sought to develop over the last decade, but it also gives the NHS, local authorities and their system partners the flexibility they need to innovate and deliver improvements in prevention, personalisation and performance in health and social care.
The challenge now will be for all of us – government, local people, health and care organisations and more - to make the best possible use of the new legislative framework to make the biggest possible difference to people’s lives. I hope that we can all stay collaborative, curious and open to innovation and improvement as this work continues.