We are strongly in favour of the duty to engage with patients, carers and representatives. We have committed to work with the Government, NHS, local government and patient and public voice organisations, to produce clear guidance to support local health and care systems to work in partnership with their communities.
Key messages
- The LGA broadly supports the Bill’s focus on improving the health and wellbeing of the population through greater integration between NHS organisations and between the NHS and local government. We also support the duty on the integrated care board (ICB) and all local authorities within the integrated care system (ICS) to have regard to the integrated care strategy in making decisions.
- We are strongly in favour of the duty to engage with patients, carers and representatives. We have committed to work with the Government, NHS, local government and patient and public voice organisations, to produce clear guidance to support local health and care systems to work in partnership with their communities.
- The LGA strongly supports the requirement for ICBs and local authorities to establish an integrated care partnership (ICP) with responsibility for convening a broad partnership and producing an integrated care strategy. It is good to see recognition of the importance of Health and Wellbeing Boards (HWBs) and the health and wellbeing strategies and joint strategic needs assessment they produce.
- We support the intention of the legislation to give local systems the flexibility to make their own arrangements for joining up services, and setting their own strategies for improving population health, but this means that there is relatively little on the face of the Bill and more emphasis will be on statutory guidance to accompany the legislation. We have already been working with the Government and the NHS on co-branded pieces of guidance, including the Thriving Places pre-implementation guidance (pdf) for ICSs on working at place level, and the engagement document on establishing ICPs. We are looking forward to continuing to work on joint guidance.
- We support the repeal of legislation related to delayed discharges. This paves the way for the continuation of discharge arrangements which have worked well during the pandemic. The emerging evidence is that going home straight from hospital is what people want. However, the policy is not fully implemented by the NHS and local government because of the ongoing pressures of Covid and the uncertainty over funding. We also need a flexible joint workforce working across health and social care to ensure that people get holistic and person-centred support to regain their independence.
- The provisions for assuring local authorities’ adult social care functions set out a new role for the CQC and the Secretary of State in the review and performance assessment of councils. We are working closely with the CQC, DHSC and other partners to ensure the assurance process is proportionate, includes a clear and continuous role for existing sector-led improvement work, and takes account of the significant financial pressures facing adult social care in their assessments.
- We are concerned that the increase in powers of the Secretary of State to intervene at an earlier stage in NHS reconfiguration proposals will undermine existing local authority health overview and scrutiny powers and corrode local accountability. As such, we are seeking amendments to Schedule 6 of the Bill which would require the Secretary of State to consult with relevant health overview and scrutiny committees in exercising this power.
- We’ve defined relevant HOSCs as (a) in relation to an area that coincides with the area of a health overview and scrutiny committee; (b) in relation to an area that may be the whole or part of the area of more than one health overview and scrutiny committee.
- Many provisions in the Bill relate to the practical steps the NHS must take to reorganise governance, staff and budgets. However, it is vital that clinical, professional, political and community leaders at local, system and national level stay focused on the broader and more challenging ambition to work together to improve health and wellbeing and reduce health inequalities, which have widened further during the pandemic.
Amendment statements
- Amendments 104 and 105, tabled by David Simmonds MP (Conservative, Ruislip, Northwood and Pinner), would require the Secretary of State to consult with relevant health overview and scrutiny committees in exercising this power. Relevant HOSCs are defined as (a) in relation to an area that coincides with the area of a Health Overview & Scrutiny Committee; (b) in relation to an area that may be the whole or part of the area of more than one Health Overview & Scrutiny Committee.
- The LGA supports this amendment as it reflects our concerns that the increase in powers of the Secretary of State to call in NHS reconfiguration proposals will undermine existing local authority health overview and scrutiny powers and corrode local accountability.
- There is already a clear process for reviewing proposals for NHS reconfigurations, which is routed in local accountability, through health overview and scrutiny processes to assess whether proposals are in the best interests of local communities. Moreover, they operate these powers in consultation with local people. Local authorities are able to refer such cases to the Secretary of State, but the best option is for cases to be resolved as close as possible to the communities they represent.
- There has been no strong call to enable the Secretary of State to intervene earlier in the process. As highlighted above, the current legislation already has a clear role for the Secretary of State in cases that are referred. Short-circuiting this process risks bypassing the existing local process.
- A key objective of the Health and Care Bill is to increase transparency and accountability. We support this aim but it does not align with the Government’s approach to accountability. Almost all the measures in the Bill to improve accountability focus on accountability upwards through Parliament and the Government. While accountability to the Government and to Parliament is important, so is local accountability to local communities and their elected representatives in local councils. There is a risk that in operating this new power, the Secretary of State, will reduce rather than increase local accountability.