In Depth: What is the impact of the Health and Care Bill on social care?

After the unveiling last week of the Government's plan for how it will fund reforms of health and social care, via a 1.25 per cent National Insurance levy, Comment Central spoke to Stephen Hammond MP, former Minister of State in the Department of Health and Social Care from 2018 to 2019, Philip Dunne MP, former Minister of State in the Department of Health from 2016 to 2018, and Sally Warren, Director of Policy at The King's Fund, about how the Government's Health and Care Bill, currently in Committee stage in Parliament, will impact social care.

How will the new Health and Care Bill impact the provision of adult social care in England?

Stephen: The Covid pandemic has brought social care to the forefront of political awareness. The Prime Minister has now announced his plans to reform what the state provides and a plan for how to fund this.

The proposals in the Bill mean social care provision in the UK will be fundamentally altered. The Bill will place an obligation on the health and care systems to align and work together more closely to deliver combined health and social care for the increasing number of our population aged over 65, and those who require support earlier in their lives.

The Bill will change the commissioning and delivery of care and it has specific measures on system assurance and data to guarantee appropriate provision and commission of social care.

Philip: The key purpose underlying the Bill is closer integration within the NHS and better joined-up working between the NHS and adult social care providers, to improve care pathways for patients. Improved discharge arrangements by removing institutional barriers during the pandemic have shown this is possible.

This closer working will take many forms, but crucial to transforming care will be the new data-sharing measures as well as the proposed new legal framework. Although these may seem technical in nature, both will remove practical barriers to joined-up care. For example, the handover of patients from hospital to care providers will become more focussed on the needs of the patient through simplified discharge arrangements.

New powers for the Secretary of State to make direct payments to providers of adult social care will provide a safety-net of intervention when required. The Bill will also remove unnecessary layers of bureaucracy enabling care providers to focus on delivering the highest standards of care, rather than filling in paperwork. As a former Minister for Health with responsibility for NHS workforce, I know that improving the flow of patients through hospitals into care will be a welcome relief to staff and lead to improved care.

Sally: There are only a few aspects of the Bill which directly relate to adult social care. These are improved data collection for adult social care, so there is more visibility nationally about the sector; giving the Secretary of State the ability to give money directly to care providers, not only to local authorities; and changing the discharge to assess process. There is nothing in the Bill on the major questions around social care, including how to tackle the workforce crisis – we are still waiting for the Prime Minister's promised plan to fix social care.

Will the Bill improve the integration between the NHS, local authorities and care providers?

Stephen: The Bill should be the mechanism to secure the oft promised integration of health and care systems. In the Bill there is an obligation on the NHS and local authorities to work even more closely together.

This duty to collaborate is put into law by this Bill. Furthermore, every region of England will be covered by an Integrated Care System within which the Integrated Health and Care Partnership will align systems and produce a plan to integrate health, public health, and social care needs. The Bill will also introduce the ability to bring in a joint appointment of executive directors. All of these measures are aimed directly at improving integration.

Philip: The Health and Care Bill has been largely based on the recommendations of the NHS's Long Term Plan and the Integration and Innovation White Paper, both of which highlighted steps to be taken to reduce inefficiency and foster collaborative working.

One of the central pillars of the Bill is the requirement for each area of England to have an Integrated Care Board and an Integrated Care Partnership. The latter's role is to ensure that local government, local NHS and local services across mental health, public health and social care are brought together to ensure holistic care models and joined-up care via tools such as pooled budgets and joint planning. The Bill will absolutely improve integration between the different bodies involved in health and care provision within a geography, with the clear aim to benefit patients and staff.

Sally: Improving integration is the main intention for the Bill – creating the right environment for NHS, public health and social care to be more joined up around people and communities. It attempts to achieve this through new Integrated Care Systems- made up of two new bodies. One body is the Integrated Care Board which holds the budget for the NHS and plans NHS services like hospitals, mental health services and primary care. The second body is the Integrated Care Partnership – this brings together the NHS, social care and public health to plan for the health and well-being of communities.

Will the Health Secretary's new power to intervene in social care provision undermine the ability of local authorities to manage services effectively?

Stephen: The new powers for the Secretary of State relating to care will allow the Government to make emergency payments directly to all social care providers. This power recognises that there are circumstances where speed of action and flexibility in provision are sometimes needed.

As this payment power is to be determined solely on a case-by-case basis and is not intended to replace the existing system of funding via local authorities, I see no basis to suggest Local Authorities are being side lined.

Philip: I acknowledge there have been some concerns expressed over new powers this Bill will grant to the Secretary of State for Health and Social Care. But having worked in the Department of Health for a previous Secretary of State, I know how important it is to have an effective system in place to ensure accountability within the NHS and allow scrutiny of the DHSC through Parliament.

The Secretary of State needs to be able to intervene when care goes wrong. The role of the CQC has expanded in recent years to take in regulation of the care sector. It seems logical that the department with responsibility for the regulator should also have responsibility for enforcing improvements in standards if the regulator identifies serious problems in the care sector, whether operated by local authorities or the private sector.

Sally: The Secretary of State's new powers about social care are limited – in this case it is to be able to provide funds directly to providers rather than always via local authorities. This is building on the experience of the pandemic, when getting funds for infection control quickly to providers was critical. The Department of Health and Social Care say that having this power does not mean they foresee the role of local authorities changing. The Care Quality Commission's role with regard to adult social care providers – including the enforcement powers they hold – are not changed by the Bill.

What lessons has the social care sector learned from the pandemic and how does the Bill reflect these?

Stephen: There is an explicit recognition that this Bill is not intended to address all the challenges. The pandemic has highlighted that the demand pattern for care is likely to change, and that those changes are likely to result in a rise in costs.

Firstly, the social care industry is extremely fragile with several large monopolistic providers and a very long tail of small and medium size providers, whose financial strength is weak.

Secondly, the number of deaths in social care will result in demands for assurances of quality. It is likely that the way the regulatory regime provides that assurance is likely to come under scrutiny.

Finally, any concern about residential care is likely to lead to an increase in domiciliary care. Although this reduces the accommodation cost it will lead to increased support costs as the need for more and better qualified carers rises.

Philip: If anything was brought into focus by the Covid-19 pandemic, it is our reliance on our National Health Service and the need for close cooperation between the health and social care sectors. The core aims of the Bill are to integrate care better, reduce levels of bureaucracy and improve efficiency.

Many of the innovations introduced in response to the pandemic will be made permanent by the Bill, such as more regular reporting of adult social care capacity to the DHSC using the Capacity Tracker Tool and other new data streams. Better patient data along with up-to-date information to and from adult social care providers will lead to better management of risk and capacity across the sector. This can help the Government to predict and respond to recruitment requirements, to gain a deeper understanding of staffing trends, to develop better equality policies and improve the working environment for staff.

Sally: The Department of Health and Social Care have used the Health and Care Bill to introduce some of the changes they believe are needed as result of lesson learnt from the pandemic. This includes for example more data in adult social care, as before there was limited visibility nationally about what was happening in the sector. There will be wider lessons from the sector, such as how providers supported each other, and how the diverse sector tried to have a unified voice during the pandemic, which don't need the Government to legislate for but will require the sector to continue to work differently as we slowly move out of the acute phase of the pandemic.

Will the Bill help to reduce or increase the bureaucracy and red-tape faced by the adult social care sector?

Stephen: The NHS and the care system have complained that the existing legislation is too detailed and prescriptive with barriers that prevent joint working. Moreover, the system of procurement under the 2012 Act has attracted criticism due to the involvement of the Competition and Markets Authority. The Government's intention was that the measures in the Bill will remove these bureaucratic barriers. The changes to the procurement regime are likely to be beneficial. However, only when the Bill has been enacted and measures in place will a reasoned judgement on their effectiveness be possible.

Philip: Reducing bureaucracy is a core aim of the Bill. This will mainly be achieved through reforming the legal framework under which service providers can operate. For instance, current legislation does not currently allow NHS providers and CCGs formally to take joint decisions. The Bill will not only make this possible but encourage pooled funds, and joint committees of two or more providers to ensure collaborative care. Equally under current legislation, it is incredibly difficult for CCGs to work seamlessly together across geographic boundaries even if adjacent. Cutting red tape that prevents sensible collaboration, like partnering local areas for joint commissioning, is at the heart of the Bill.

These measures should make the NHS a better partner for the adult social care sector to work with, streamlining processes and encouraging multi-discipline working – without silos creating bureaucracy – to allow for more seamless provision of care and greater efficiency in dealing with the NHS for those working in the care sector.

Sally: The Bill's measures about bureaucracy are in the main targeted in the NHS rather than social care, such as the requirement in the NHS to tender for clinical services being amended. There is likely to be limited impact for social care providers.