The 1st April saw the biggest reform to the NHS in its 65-year history, bringing big changes for health professionals in England. But what does it means for their social workers and social care and for integrated working between the two services?

The reforms will affect joint working (Credit: Burger/Phanie/Rex Features)

On 1 April, hundreds of NHS organisations were abolished, while hundreds of others were created and existing bodies gained responsibilities.  This is a big change for NHS staff but will also affect social care professionals, who will not only have to learn a whole new set of acronyms, abbreviations and jargon but get to grips with how the reforms will impact on them and their clients.AdTech Ad

The Health and Social Care Act 2012 has abolished the 153 primary care trusts (PCT’s), responsible for health commissioning, and the nine strategic health authorities, responsible for performance managing the NHS in their regions. It also signals the abolition of remaining acute, mental health and community NHS trusts; they are all expected to become merged with more independent foundation trusts, or be dissolved over coming years.AdTech Ad

There are now 211 clinical commissioning groups (CCGs), led by GPs, to take over responsibility for most health care commissioning with a combined budget of £65bn. They are overseen and accountable to NHS England, which will commission specialist services and primary care and operate regionally through 27 local area teams. CCGs are supported by 19 commissioning support units (CSU’s), whose functions will include contract management of providers, procurement and service redesign.It is arguably a more complex NHS for the social care sector to engage with. Most of the 152 councils in England shared the same boundaries with their local PCTs, meaning they only had one commissioning partner in the NHS; but many will now have to engage with more than one CCG and all councils will have to forge strong relationships with CSU’s and NHS England local area teams. For instance, NHS England is responsible for disbursing £859m of funding for councils to spend on social care services that benefit the NHS in 2013-14, a function previously carried out by PCTs.

The reforms are designed to help ensure the long-term sustainability of the NHS at a time of rising drugs costs and demand from an ageing population, by achieving much better value for money and shifting care out of hospital into the community. CCGs are expected to use their clinical knowledge to purchase more efficient services than more remote PCT managers. In addition, they will be encouraged to tender out services to any provider that meets required standards, so that competition can be used to drive up standards.This should also encourage closer integration between health, social care and other related services, on the grounds that this will deliver better value for money and improved care. PCTs’ public health responsibilities, and almost 3,500 staff, have been transferred to councils, on the assumption that councils’ responsibility over related areas, including housing, leisure and social care, will lead to more effective practices and reduce the strain on the NHS. As part of this, councils will take responsibility for commissioning substance misuse treatments.As part of the reform is the aim to improve the ability of patients and the public to hold the NHS to account through the creation of new patient representative organisations, Healthwatch England and local Healthwatch groups these will focus on social care as well as health.

The Health and Social Care Act 2012 promotes joint working between health and social care, principally through the creation of health and well-being boards (HWBs) to oversee services in each area. These are committees within every council with social services responsibility, including representation from CCGs, the local Healthwatch and the directors of children’s and adults’ services. CCGs and HWBs will also be under a duty to promote integration of health and social care.

CCGs have inherited PCTs’ responsibilities for safeguarding children. Like PCTs, they must appoint a designated doctor and nurse with responsibility for safeguarding children and looked-after children, to provide advice and leadership to NHS bodies and professionals in their area; CCGs and NHS England also sit on every local safeguarding children board.Every CCG must also have a designated adult safeguarding lead, to oversee inter-agency working with councils and the police and ensure systems are in place for responding to abuse or neglect in NHS-funded services.  Each NHS England local area team has a director of nursing with overall responsibility for safeguarding adults and children in their NHS area; this will include commissioning any enquiries or reviews of services provided by independent contractors.CCGs must also have a Mental Capacity Act lead, whose responsibilities will include that the care commissioned by the group is compliant with the MCA and the Deprivation of Liberty Safeguards (Dols).However, councils are now responsible for authorising deprivations of liberty in hospitals, a role previously carried out by PCTs. Councils are also now responsible for commissioning independent mental health advocate (IMHA) services for people detained under the Mental Health Act or subject to community treatment orders.

CCG’s have inherited PCTs’ responsibilities for NHS continuing health care and nursing care for people in residential care. This role involves commissioning assessments by a multi-disciplinary team of people most likely to be eligible for continuing care – often following an initial screening assessment – with eligibility determined using a prescribed decision support tool. The CCG is also responsible for commissioning places and care management for those deemed eligible.   are expected to involve local authorities in this process. There is an expectation that CCGs may delegate some of their continuing health care functions to commissioning support units; however their statutory duty to determine eligibility cannot be delegated.The full impact of the NHS reforms on social care will become clear over the coming months. The immediate challenges for social care professionals, managers and providers is understanding how the pieces of the new NHS jigsaw fit together, who they should be doing business with locally and how they can influence the new health landscape in a way that most benefits social care clients.

Home Care Direct has a long history of working with health and social care professionals and truly believes that the bringing together to services and partnership workings of all professionals involved should reach the best outcomes for people in need of services.If you have any thoughts on these issues that you would like to share with us, please get in touch with us here