What will the Health and Care Act do for child health?
Following months of scrutiny, debate and a frenzied ‘ping-pong’ in its final few days the Health and Care Bill became law in England as the Health and Care Act 2022 at the end of April. It is the most significant piece of health legislation we have seen in a decade and it marks a new chapter for health services in England.
The driving intention of the Act is to establish Integrated Care Systems (ICS) across 42 areas in England in statute. These will bring together providers and commissioners of NHS services with local authorities and other partners to collectively plan health and care services to meet the needs of the local population. In short, to better integrate hospital and community-based services, physical and mental health facilities, and health and social care.
Realising the benefits of ICSs for children and young people
This move is especially important for children and young people. RCPCH recognise that delivering shared priorities through greater integration and partnership working is essential to reduce health inequalities and to improve health services for children and young people. Our landmark report, Paediatrics 2040 identified integration as a key enabler for improving care, noting that it has the potential to dramatically reduce or even reverse forecast increases in attendances. In turn this would reduce strain on the system whilst improving outcomes for family and young people’s experience of care.
“Time and time again the specific needs of children are forgotten when set against those of the rest of the population”
It was clear from the outset that the Bill needed strengthening to fully realise the potential of integrated care for children and young people. Despite running to a mammoth 300 pages, the Bill included just a handful of mentions of children and young people.
This was a stark oversight given the impact of the COVID-19 pandemic on children’s health and wellbeing, which itself is layered onto some of the worst child health outcomes in Europe. Time and again, the specific needs of children are forgotten when set against those of the rest of the population; analysis by YoungMinds, a mental health charity for young people, found that 77% of Sustainability and Transformation Partnerships — an earlier iteration of ICSs — failed to sufficiently consider children’s needs.
Getting children at the heart of the Health and Care Act
The process of how a Bill moves through Parliament allows time for detailed scrutiny including from individuals and organisations, such as RCPCH. Expert evidence can be provided to parliamentarians who can then propose amendments to the Bill itself. It was through this process that, in collaboration with other child health organisations and members of the House of Lords who campaign for child health, RCPCH secured major changes to the Bill that put children and young people at the heart of the statutory framework.
For example, the Government confirmed that new statutory guidance will require Integrated Care Boards (ICBs) to nominate an executive children’s lead. They will be responsible for ensuring the ICB sets out clearly the steps it will take to address the needs of those aged 0–25. Over the past six months RCPCH highlighted that not including this in the new legislation would risk children and young people being forgotten in planning and commissioning decisions. The move should enable a system-wide view across all services for those aged 0–25 for high quality, safe and effective integrated services.
“…RCPCH secured major changes to the Bill that put children and young people at the heart of the statutory framework.”
The UK Government also accepted the argument made by the Health Policy Improvement Group (HPIG), which RCPCH are a member of, that it should be a legal requirement for ICBs to set out the steps it will take to address the needs of children and young people in their five year forward plans. ICBs will now be required to consult with local leaders as they draw up their plan. They will also need to report annually on how well they are delivering their duty to safeguard children and consult with local leaders, including those in the children’s sector, as they draw up their plans and strategies. Taken together, these are meaningful enablers for high-quality services that meet the health and safeguarding needs of every child and young person.
The UK Government was also persuaded of the need to outline the steps it will take to improve information sharing including on potentially implementing a consistent unique identifier. This has been acknowledged as a real barrier to collaborative working and such a move would support paediatricians and other professionals interacting with children to provide better care. Within a year, the Government will now need to publish a report that sets out actions it will take to improve information sharing across health, education, and social services.
Workforce planning
A major caveat to all of this is that the Government failed to reach a compromise with MPs on an amendment that required the Health Secretary to publish regular, independently assessed health and care workforce projections. This went against the wishes of over 100 health organisations, including RCPCH, and a passionate cross-party group of MPs and Peers many of whom, such as Lord Stevens, former Chief Executive of NHS England, come with years of experience in the health sector.
“this Act certainly provides a more solid foundation from which paediatricians should be better supported to improve the health and wellbeing of children and young people.”
The Minister responded that the Department for Health and Social Care (DHSC) has commissioned a long-term strategic framework in addition to a long-term workforce strategy from NHS England, so the amendment was unnecessary. However, neither provide clear projections of the numbers of staff needed to keep up with demand.
The lack of robust workforce planning will continue to be a barrier to improving child health and supporting the workforce now and into the future.
A foundation of support for paediatricians
Now that the Bill has received Royal Assent it is expected that NHS England and DHSC will soon publish the associated statutory guidance. This will shed further light on what will be expected from the likes of the executive children’s lead as well as how Integrated Care Partnership (ICP) strategies can support children’s health and wellbeing.
Of course, the law and associated guidance is not a panacea in and of itself, but the passing of this Act certainly provides a more solid foundation from which paediatricians should be better supported to improve the health and wellbeing of children and young people.
RCPCH members who are interested in contributing to our public affairs and campaigns work in Westminster can get involved in our Parliamentary Panel.
