NHS Integration Reform: A Huge Task - Cantium Insights
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By Steve Whiting, client director at Cantium


Matt Hancock’s recent announcement and the subsequent white paper on upcoming reforms to health and social care have been in the news.  There is no doubt that, over the last year, collaboration across health and social care has accelerated, supported by the adoption of new technology focused on the needs of the patient. We have seen for example significant increases in online consultations. Whilst the NHS integration reform outlined in the white paper is welcome and presents an opportunity for real change, the question is whether this is a major priority for many decision makers in the NHS right now. They will undoubtedly know these changes are happening, but have they had the breathing space to turn their attention to wider strategies, even if it means they could partly escape the current web of rules and regulations?

The timing of this announcement has indeed pushed  integration back up the agenda within health and care organisations. My only concern is that it will only happen when they have the headspace, the time and the resources for it. Covid and responding to the impact of the pandemic is the healthcare system’s biggest challenge right now, and whilst the value of integrated care has moved up the agenda operationally, fighting this immediate threat may mean that there isn’t time for the large infrastructure change and resource required to reform the system.


Collaborative Commissioning


The reforms within these legislative proposals will remove the current procurement rules which apply for NHS and public health commissioners when arranging healthcare services.

The powers within the bill are intended to develop a new provider selection regime which will provide a framework for NHS bodies and local authorities to follow when deciding who should provide healthcare services.

These reforms will only apply to the arrangement of healthcare services – including public health services whether commissioned solely by a local authority or jointly by the local authority and the NHS. The procurement of non-clinical services, such as professional services or clinical consumables, will remain subject to Cabinet Office public procurement rules.

The balance between a centralised decision-making approach and an approach based around local partnerships is always a difficult one, ensuring that there is room for innovation with the right partners and solutions that work in the local environment. Whilst there is the opportunity to significantly improve the provision of integrated care by removing the barriers to achieving it, it’s important that this does not limit the options in terms of the delivery to the local patient.


ICS Restructure leaves questions


It’s the same story with the new Integrated Care Systems (ICS) structure: how is there the time to get this onto the NHS’s agenda? While the ICS restructure was already happening prior to the pandemic, it has inevitably been impacted by recent events. Some areas are still working on implementation, but pushing for anything unrelated to Covid is a difficult ask right now.

No-one yet understands the practicalities of these reforms. There are governance and accountability considerations, with the services having entirely different legislative basis, that need to be ironed out. With local authorities and NHS organisations working together on resources there are complexities that will be difficult to resolve. How are the newly formed ICS organisations going to be supported through this transformation? This is not the first time this has been attempted, what will make the difference this time?

Cantium’s work with the Kent & Medway Care Record is a good example of bridging the gap between councils, NHS and key organisations in the region, sharing data and working together. The interplay of these different organisations can be quite complex, but by working together we are currently mobilising the solution to enable health and social care professionals to see a single view of each and every patient in the region.

We all applaud the intention of integrating health and care and the right noises are being made, but until we are much further down the line with recovery this vision will be difficult to make turn into reality. It’s a huge task, even when the NHS is ‘business as usual’ – and we are far from that at the moment