A report commissioned by Labour on how to bring about integrated care has backed an evolutionary approach to giving health and wellbeing boards the lead role in planning local services.
The “whole person care” review was commissioned by the party, but carried out by GP and a former Department of Health director Sir John Oldham.
HSJ reported in January 2013 that Labour had begun exploring the possibility of transferring the NHS commissioning budget to local authority control with clinical commissioning groups acting in an advisory role. These ideas appear to have been refined – with many commentators saying such a move would require significant re-organisation, something the party said it was keen to avoid.
The Oldham report claimed further structural change was not required, and that CCGs should be retained and their budgets largely left intact.
However, the report does state health and wellbeing boards “or analogous local arrangements” should provide “the collective system leadership for services for people with multiple long term conditions, disability and frailty”.
It adds that boards should be “responsible for a collective commissioning plan” which utilised the total health and social care budget for “this cohort of the population”. The reports calls for “a statutory duty [to be] placed on commissioners (Local Authority and CCGs) to enact the collective commissioning plan.”
These joint commissioning arrangements would “require development” and commissioners would have to “demonstrate readiness” before taking on the role. A single pooled health and social care budget should only be brought in where both sides wish that to happen.
Over the lifetime of the next parliament, £10bn should be identified “from within allocated resources to strengthen community health and social care services”. This should be routed via NHS England – which Sir John proposes renaming as Care England.
The report makes no mention of two other key policies proposed by Mr Burnham: that NHS trusts should be the “preferred provider” for the service or that part three of the Health Act 2012 should be completely repealed.
However, the Oldham report recommends that Section 75 regulations – which were introduced under the Health Act to govern procurement and competition – should be abolished, and “replaced with new regulations which support the development of whole person care”. Meanwhile the role of the Office of Fair Trading “in reviewing competition decisions should be removed”.
Sir John Oldham’s report also recommends:
- There should be “an independent national conversation” review, looking at the future of health and care funding and entitlement, and also at the configuration of health services. It should be completed within a year of the general election, with legislation enacted to enable implementation from 2020 onwards.
- The benefits should be “considered of a single regulator covering issues of both care and economics, whilst recognising that is not feasible at present”. Such an arrangement would see the functions of the Care Quality Commission and Monitor merged.
- Continued reform of payment systems, towards whole person capitated approaches.
- “The continuation of clinical senates is of questionable value for whole person care and should be abolished.”