Recommendations & Conclusions
6 items
3
Recommendation
Thirty-Fifth Report - Introducing Integ…
Rejected
The Department has started taking some action to address workforce challenges in social care, but vacancies have increased by 50% in the last year and the number of people working in social care fell in 2021/22 for the first time in at least 10 years. The NAO report sets out …
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The Department has started taking some action to address workforce challenges in social care, but vacancies have increased by 50% in the last year and the number of people working in social care fell in 2021/22 for the first time in at least 10 years. The NAO report sets out a very high level of social care vacancies in ICSs of up to 13%, and high turnover rates ranging from 23% to 37%. The Department has taken some action to improve the situation, including adding care workers to the shortage occupations list and launching a national advertising campaign. It told us that numbers of both domiciliary workers and care home staff are now increasing. However, as written evidence to this committee sets out, there are now 165,000 vacancies in social care, compared with 110,000 in 2020/21, and the workforce has decreased by 3% in the last year. We challenged the Department on what the £500m it has committed for social care reform would achieve, and it stated this money would be used to support discharge to assess and other measures for domiciliary care. Recommendation: Alongside its Treasury Minute response, the Department should: • write to us by the end of March 2023 and provide a breakdown of how it spent and what impact it achieved, in terms of health outcomes as well as operational improvements, from both the £500m committed to workforce reform in December 2021, and the £500m announced in September 2022 to tackle delayed discharge. • The Department should also write to us within six months setting out the underlying reasons for social care vacancies, its forecasts for them, and its further plans to address them.
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Government response AI summary
The government disagrees with the committee’s recommendation to provide a breakdown of how it spent and what impact it achieved and to set out the underlying reasons and forecasts for social care vacancies. The department will publish additional information on what it is doing to …
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HM Treasury
4
Recommendation
Thirty-Fifth Report - Introducing Integ…
Rejected
These reforms do nothing to address the longstanding tension caused by differences in funding and accountability arrangements between the NHS and social care. The Department, which has policy responsibility for both health and social care, is showing a worrying lack of leadership, and it is not clear who will intervene …
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These reforms do nothing to address the longstanding tension caused by differences in funding and accountability arrangements between the NHS and social care. The Department, which has policy responsibility for both health and social care, is showing a worrying lack of leadership, and it is not clear who will intervene if relationships between local partners break down. The interdependency between health and social care services is well established. However, we are concerned these reforms will be a missed opportunity to make meaningful progress on how the NHS and local government can work together. The NHS and social care continue to maintain separate budgets despite the ambition of integrating services through these new reforms. NHS oversight is focused on the NHS’s objectives and while the CQC can identify problems in joint working, it is not clear how the Department intends to resolve them when they do arise. It is Introducing Integrated Care Systems 7 essential that MPs can support their constituents when they encounter problems with health and social care services, but the arrangements for doing so within ICSs are very patchy. Recommendation: The Department should, within six months, publish guidance for ICSs setting out how it will support systems to resolve joint working issues when these are identified by the Care Quality Commission.
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Government response AI summary
The government disagrees with the recommendation to publish guidance for ICSs on resolving joint working issues, stating that the existing structures and processes are designed to ensure partners support each other.
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HM Treasury
11
Conclusion
Thirty-Fifth Report - Introducing Integ…
Rejected
There is a well-established interdependency between health and local government, with local authorities responsible for managing local social care markets. The stability and resilience of social services have a direct impact on the NHS. High-quality social care, if available, can keep people independent, healthy, and out of hospital.31 Despite the …
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There is a well-established interdependency between health and local government, with local authorities responsible for managing local social care markets. The stability and resilience of social services have a direct impact on the NHS. High-quality social care, if available, can keep people independent, healthy, and out of hospital.31 Despite the aspiration for ICSs to better integrate health and care, we are concerned the underlying reforms do not address long-standing differences between the sectors and may be a missed opportunity to make more meaningful progress on how the NHS and local government work together. The NHS and social care continue to maintain separate budgets and we challenged our witnesses on whether this is the best way to ensure people receive the services they need.32 NHS England highlighted pre-existing mechanisms such as the Better Care Fund, which has been in place since 2015, as a way for the NHS and local authorities to collectively pool budgets and agree how the money is then spent locally, and the Department wrote to us after the evidence session with examples of how the fund has been used and to what benefit.33 However, the Department noted several times during the session that the ICS reforms are not intended to alter the funding that either the NHS or local government receives or change existing accountabilities and statutory responsibilities, but are instead intended to provide a forum for better decision-making to take place.34
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Government response AI summary
The government disagrees with the committee's recommendation, stating that the Health and Social Care Act 2022 is designed to ensure partners support each other and that they will take action if arrangements are not working.
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HM Treasury
12
Conclusion
Thirty-Fifth Report - Introducing Integ…
Rejected
The oversight of ICSs largely focuses on the NHS elements, and we are concerned the wider system is being overlooked. NHS England has established a very detailed performance regime to monitor Integrated Care Boards’ contributions to NHS objectives. NHS England confirmed to us that it retains its power of intervention, …
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The oversight of ICSs largely focuses on the NHS elements, and we are concerned the wider system is being overlooked. NHS England has established a very detailed performance regime to monitor Integrated Care Boards’ contributions to NHS objectives. NHS England confirmed to us that it retains its power of intervention, and that if a provider or system was under performing it would expect to pick that up very quickly and provide appropriate support.35 Arrangements for evaluating how the overall system is functioning, including ensuring that local partners are working well together, are less clear.36 We asked the Department what happens in the event of a disagreement between the NHS and local partners, and it told us that while existing intervention powers across both health and social care remain unchanged, the Care Quality Commission will now have a new role to look at the effectiveness of partnership working locally.37 However, as the NAO’s report points out, the Care Quality Commission’s role will focus on monitoring, assessing and reporting, and it will not have any direct enforcement powers over ICSs.38 The Department has policy responsibility for both health and social care, and 31 C&AG’s Report, para 2.34, ICS0012, ICS0039 32 Q 53, ICS0039 33 Qq 53–54, Committee of Public Accounts, Integrating health and social care, Sixtieth report of Session 2016–17, HC 959, 27 April 2017, and letter dated 18 November 2022 from Chris Wormald at the Department of Health & Social Care to the Committee 34 Qq 108, 133, 139, 142, 35 Q 28 36 C&AG’s Report, para 13, ICS0011 37 Qq 112, 147, C&AG’s Report, para 1.32 38 C&AG’s Report, para 1.32 Introducing Integrated Care Systems 13 when pressed on what it would do in the event of the Care Quality Commission flagging an issue within an ICS that cut across both sectors, it was unable to describe the steps it would take to support ICSs to get back on track.39
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Government response AI summary
The government disagrees with the Committee's recommendation, stating that the Health and Social Care Act 2022 is designed to ensure partners support each other and that they will take action if arrangements are not working.
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HM Treasury
13
Recommendation
Thirty-Fifth Report - Introducing Integ…
Rejected
NHS England noted the importance of ICSs’ Integrated Care Boards working constructively with the full range of local partners, including local government, elected members, community groups and the voluntary sector.40 We highlighted the necessity of MPs being able to raise issues on behalf of their constituents who encounter problems with …
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NHS England noted the importance of ICSs’ Integrated Care Boards working constructively with the full range of local partners, including local government, elected members, community groups and the voluntary sector.40 We highlighted the necessity of MPs being able to raise issues on behalf of their constituents who encounter problems with health and care services, but noted members’ experiences of trying to engage their local NHS have at times been inconsistent and unsatisfactory.41 NHS England offered to write back to us setting out who MPs can approach within their local ICS to resolve issues for their constituents, and how it will remind ICSs of the importance of working effectively with local MPs.42 It has since written to us to provide information from MPs and we look forward to receiving confirmation that it has similarly communicated with ICSs.43 Capital investment in the NHS
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Government response AI summary
The government disagrees with the recommendation, stating that the Health and Social Care Act 2022 is designed to ensure partners support each other and resolve issues together, further reinforced by the NHS Act 2006's duties to co-operate.
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HM Treasury
19
Recommendation
Thirty-Fifth Report - Introducing Integ…
Rejected
The Department told us numbers in the social care workforce were going in the right direction and that domiciliary care and care home workforces were expanding.70 However, written evidence sent to us by the National Care Forum highlights that, as of October 2022, there were 165,000 vacancies in the sector …
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The Department told us numbers in the social care workforce were going in the right direction and that domiciliary care and care home workforces were expanding.70 However, written evidence sent to us by the National Care Forum highlights that, as of October 2022, there were 165,000 vacancies in the sector according to Skills for Care’s most recent 2021–22 annual report.71 This is an increase of 50% compared to the 110,000 vacancies in 2020–21, and represents a 3% contraction of the social care workforce over the previous year in the face of increasing demand.72
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Government response AI summary
The government disagrees with the Committee’s recommendation, stating that they don't hold further information to explain the underlying reasons for social care vacancies and don't produce forecasts for vacancies.
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HM Treasury